Quick Facts: ADT for Prostate Cancer

• 44% of patients with prostate cancer undergo ADT
• Common side effects are depression, fatigue, erectile dysfunction
• In the past studies have had mixed results about ADT effect on cognitive function
• Similar cognitive effects occur with chemotherapy – known as “chemo brain”

What is Prostate Cancer Hormone Therapy?

Hormone therapy, or androgen deprivation therapy (ADT), is used to suppress a man’s testosterone level in hopes of starving the prostate cancer tumor. The goal is to shrink the tumor or cause it to grow more slowly, but hormone therapy is not a prostate cancer cure.

Is hormone therapy the right treatment?

Since hormone therapy does not remove the prostate or eliminate prostate cancer, it does not provide the same level of cancer-free assurance as robotic prostate removal. Hormone therapy may be best suited for men of advanced age, those who are not surgical candidates, or for those whose cancer has returned.

PROS of Hormone Therapy

• Can help stop the growth and/or spread of cancer in the prostate
• Can shrink an enlarged prostate

CONS of Hormone Therapy

• Can lead to erectile dysfunction
• Can cause osteoporosis
• Loss of libido
• Decrease in muscle mass
• Hot flashes
• Breast enlargement
• Decreased mental acuity
• Blood in the urine
• Depression

What are the side effects of prostate cancer hormone therapy?

Bone weakening and bone loss are the primary concerns associated with hormone therapy. Cancer Treatment-Induced Bone Loss (CTIBL) related to ADT is widely studied and proven. A 10-year study published in 2013 demonstrated that ¼ of hip fracture patients had previously been treated with ADT for low-risk prostate cancer.

Kidney damage is another concern resulting from hormone therapy. A separate 2013 study found a significantly increased risk of acute kidney injury (AKI) among hormone therapy patients with advanced, non-metastatic prostate cancer.

Other potential side effects of hormone therapy include:

• Impotence and/or loss of libido
• Testicle and penis shrinking
• Hot flashes and breast tenderness
• Osteoporosis and anemia
• Weight gain and loss of muscle mass
• Fatigue and depression

Also called ADT, the levels of male hormones (or androgen) are reduced in the body to stop the growth of prostate cancer cells.

Recommended for:

• Men with advanced or high-grade prostate cancer
• Men whose prostate cancer has spread beyond the prostate and are no longer candidates for surgery or radiation
• Men with recurring prostate cancer
• .

New Study: Hormone Therapy May Impair Men's Thinking Skills

The current literature around treating prostate cancer with androgen deprivation therapy is mixed as to the effect that ADT has on the brain. 

But most agree that decreased mental sharpness, and memory problems are a side effect of hormone therapy. Because there are different things that can affect brain function. This study examined demographic and genetic predictors of impaired brain function.

58 PCa patients were assessed before starting ADT, 6 months after, and 12 months after. Age and education matched PCa patients treated with a prostatectomy, and men without PCa assessed at the same intervals.

Participants provided baseline blood samples for genotyping:

• Cognitive performance was compared
• Cognitive impairment was estimated

Results:

• Men receiving ADT had higher rates of impaired cognitive performance over time
• Relative to ALL controls
• Baseline age, cognitive reserve, depressive symptoms, fatigue, and hot flash interference did not impact impaired cognitive performance for those receiving ADT
• Men treated with ADT were more likely to have impaired brain function within 6 months of starting ADT.
• Continue to demonstrate impaired cognitive function within 12 months of ADT. This will be important for patients receiving the treatment.

Patient education around prostate cancer hormone therapy treatment is critical. Patients should know risks and side effects of treatments.