Androgens are a group of sex hormones commonly associated with growth and reproduction. While normally linked to the development of “male” characteristics, women also produce a small amount of androgens.  

How are Androgens Related to My Cancer? 

In prostate cancer, the androgens we often refer to are testosterone and dihydrotestosterone. These hormones are responsible for stimulating the growth of most prostate cancer cells.

Androgen deprivation therapy (ADT) is the purposeful reduction of androgens in the body by either surgery or medication. In doing so, the growth of prostate cancer usually slows or stops but usually does not cure the cancer. The goal of ADT (with medication) is to lower the testosterone level at least to the same extent as that achieved with surgical orchiectomy (see below). 

How is Androgen Deprivation Achieved? 

Surgery  

• Bilateral orchiectomy (also known as surgical castration) is the removal of both testicles. Because most androgens are produced by the testicles, this is the simplest and most definitive form of androgen deprivation. The procedure is quick, effective, and done in the outpatient setting. The result is that prostate cancer shrinks or stops growing because of rapid decrease in testosterone levels. In North America and Europe, this procedure is infrequently done primarily due to the psychological effects and permanence. Bilateral orchiectomy remains the standard for androgen deprivation of care in developing countries as it is a much cheaper alternative to “medical castration” with medications. 

Medications 

• Luteinizing hormone-releasing hormone (LHRH) agonists are one type of drug that stops the testicles from producing androgens. These are given either by injection or placed as implants under the skin. Depending on the drug and treatment plan, they can be given anywhere from once a month to once every six months.  

  • Some of the most common LHRH agonists are Leuprolide (Lupron), Goserelin (Zoladex), and Triptorelin (Trelstar). 

• LHRH antagonists are drugs that lower the androgen level more rapidly and do not cause the tumor flare (see below) seen in LHRH agonists.  

  • Some of the most common LHRH antagonists are: Orgovyx, which is an oral drug, and Degarelix which is an injection. 

• Anti-androgens block the production and action of male hormones such as testosterone. They are pills taken daily and are most often used in combination with surgery and/or other medications.

  • The most common anti-androgens are bicalutamide, flutamide, enzalutamide, and epalutamide. 

What Side Effects Can I Expect? 

While side effects may vary depending on the type of deprivation therapy you are receiving, some of the more common side effects include: 

• Low libido

• Shrinkage of penis and testicles 

• Erectile dysfunction 

• Hot flashes

• Osteoporosis

• Weight gain 

• Fatigue

• Tumor flare (This is unique to LHRH agonists and can cause bone pain, trouble urinating, or spinal cord compression.)

Fortunately, many of these side effects can be prevented or treated with other drugs, treatments, and lifestyle changes.  

Are There Any Other Considerations to Be Aware Of? 

Over time, prostate cancer can stop responding to any of the above forms of treatment. The cancer cells that had stopped or slowed growth can start to progress again despite the low levels of testosterone. This is called castration-resistant prostate cancer (CRPC).

In these cases anti-androgens can be added to LHRH antagonists or agonists, or if you are already on anti-androgens they can be stopped or switched to a different drug. Your doctor will help you determine the combination and/or sequence of medications that is most appropriate for you.  

For more information about ADT and Prostate Cancer, reach out to one of our Iris Nurses via phone call or messaging.