Prostate Cancer Hormone Treatment: Androgen Deprivation Therapy (ADT)

Once you have been diagnosed with prostate cancer, your clinician will consider if prostate cancer hormone treatment is needed as well. This is referred to as Androgen Deprivation Therapy (ADT). It works essentially by starving the prostate cancer of its driving force which is testosterone, an androgen. This can shrink or slow the growth of prostate cancers. ADT by itself, does not cure prostate cancer but when used in combination with external beam radiotherapy in selected patients, studies have shown a synergistic effect and can lead to improved control of prostate cancer and better overall survival than without it. It does come with a number of side effects and not everyone will be suitable for ADT. Ask your treatment team whether you’d benefit from this treatment as well.

The recommendation for ADT will take into account your suitability for hormone treatment, the aggressiveness of the disease based on your biopsy result, the PSA count and also the extent of disease. In particular, the extent of disease is important to check if you have a higher risk prostate cancer. Prostate cancer can spread to pelvic nodes or more widely to other areas of the body outside of the pelvis. This will be assessed through the use of scans. Once prostate cancer has spread outside the prostate, we refer to this as metastatic prostate cancer. Unfortunately, this may no longer be curable but there are a number of means of controlling it to slow down progression and still maintain a good quality of life for a significant period of time. ADT is one of this means. Please don’t lose heart as the number of treatments for metastatic prostate cancer are increasing and I would recommend you have an open discussion with your clinician regarding your options.

There are a number of ways of achieving hormonal control of prostate cancer. This can include tablets or injection that reduce testosterone, tablets that block androgens or by simply removing the testicles through an operation called an orchidectomy. More commonly available ADT medications include: Goserelin (Zoladex®), Abiraterone (Zytiga®), Enzalutamide (Xtandi®), Bicalutamide (Cosudex®, Calutex®), Cyproterone (Androcur®, Cyprone®, Procur®) amongst others.

I commonly use an injection administered into the fatty layer of the belly once every 3 months. This can be administered through your own family physician or practise nurse. The length of time you will be on this will depend on a number of factors relating to the tumour and your tolerance as well. Typically, it can be as short as between 4 to 6 months or as long as up to 2 years. In some situations, you may also be recommended to be on ADT lifelong.
Suppressing or blocking testosterone with ADT will result in a number of side effects. Some men do not find it a bother at all while others can struggle with ADT and it can aggravate some underlying pre-existing medical conditions as well. These side effects and their likelihoods can be discussed with your radiation oncologist or other clinicians as well.

The more common and cumbersome side effects are that of hot flushes, fatigue, mild cognitive impairments, weight gain, breast/nipple tenderness and enlargement, osteoporosis and mood disturbances. ADT will result in sexual dysfunction and you will lose you libido and have no erections. ADT can also increase the risk of diabetes and cardiovascular disease such as strokes and heart attacks. It is therefore important you keep up regular visits to your family physician to reduce your risk of cardiovascular disease with monitoring of your cholesterol, blood pressure, blood sugar levels and engage in a suitable regular exercise program. If you are a smoker, please talk to your doctor about ways to help you stop smoking as this may have a significant advantage in reducing your risk of cardiovascular events.

Some of the side effects of ADT are reversible after stopping it but recovery from some of the effects may take a long time before you note a significant improvement.

I recommend you look up the EVIQ website for further information on ADT.

© Ramesh Pandey March 2025