Taking Androgen Deprivation Therapy (ADT) for Prostate Cancer
Most prostate cancers need testosterone to grow. Testosterone is a male sex hormone (called an androgen) that is produced by the testes and adrenal glands. One treatment for prostate cancer is to decrease the body's production of testosterone or block it from working. A group of medications called anti-androgens (bicalutamide, nilutamide, flutamide) work by blocking testosterone receptors on prostate cancer cells. A second class of medications called LHRH agonists (lutenizing hormone releasing hormone agonist, including goserelin, degarelix, leuprolide) work by stopping the pituitary gland from making lutenizing hormone, which in turn is responsible for causing testosterone to be produced. Two other medications, degarelix, an LHRH antagonist, and abiraterone acetate, a CYP17 inhibitor, are also used as anti androgen therapies in advanced prostate cancers, high risk prostate cancer and castrate-resistant prostate cancer. Talk with your healthcare provider about the type of medication being prescribed to you.
While interfering with testosterone can slow or stop the growth of prostate cancer, these medications can lead to some significant side effects.
While interfering with testosterone can slow or stop the growth of prostate cancer, it can have some unpleasant side effects. These can include:
- Sexual dysfunction
- Hot flashes
- Loss of muscle
- Osteoporosis (thinning of the bones)
- Weight gain (particularly in the belly)
- Increased risk of diabetes and high cholesterol and possibly cardiovascular problems such as stroke and heart attack.
The following are tips and resources for managing these side effects.
Sexual Dysfunction & Body Image Concerns
ADT causes a loss of libido (sexual desire) in a majority of men. This tends to occur within the first few months of therapy, followed by erectile dysfunction (decreased ability to obtain or maintain an erection; also called ED or impotence). Libido typically returns a few months after androgen deprivation therapy has been completed. Depending on other cancer treatments and other medical problems, erectile function also recovers for many men.
Keep the lines of communication open between you, your partner and your healthcare providers. Don't let fear or embarrassment ruin your relationship. Educate yourself about ED. Ask for help from your urologist, who is trained in the treatment of ED. Finally, consider seeing a sex therapist, which can be very helpful for couples facing these side effects.
In addition to ED, ADT can also cause a temporary increase in breast tissue (called gynecomastia), a decrease in the size of the penis and/or testicles, and a thinning of body hair.
Osteoporosis is a decrease in bone density (thinning of the bones) that can lead to fractures (broken bones). There are things you can do to lower your risk of a fracture and strengthen your bones.
- Get 1000-1200mg a day of calcium
- It is best to get calcium in a balanced diet, including 4-8 servings of calcium rich foods a day. Examples of calcium rich foods are low fat milk, yogurt, cheese, green leafy vegetables, nuts, seeds, beans, legumes and calcium fortified foods and juices.
- A dietitian can provide more guidance in choosing calcium rich foods. A good resource is www.myplate.gov
- If you cannot take in the recommended amount of calcium in foods, take calcium citrate petite supplements (250mg of calcium per tablet). Your body does not absorb calcium supplements well, so spread the dose out by taking 1 tablet multiple times a day. If you take synthroid (thyroid hormone), separate it from calcium doses by at least 4 hours.
- Take 1000 IU of vitamin D-3 daily
- Your healthcare provider may check blood levels of vitamin D with the 25-OH Vitamin D blood test.
- Do not take more than 2000 IU of vitamin D3 a day unless directed by your healthcare provider.
- Bone strengthening exercises
- Before you start an exercise program, check first with your healthcare provider. If you have cancer that has spread to your bones, then a healthcare provider should help you determine if weight lifting is safe for you.
- Start with what is comfortable for you and work up to the following recommendations:
- Get 30-40 minutes of weight bearing exercise 3 times a week. Weight bearing exercises are those in which your feet or legs bear your body's weight while the bones and muscles work against gravity. Examples include: walking, jogging, Tai Chi, yoga and dancing.
- Strength training should be done 2-3 times per week with a day of rest in between each session. Complete 8-12 repetitions of the exercises below, and repeat them two times (2 sets). Choose a weight where the tenth repetition is hard for you to complete and you can't complete an 11th time. Now remove 1-5 pounds from that "maximum weight," and use that as your training weight. When you can easily do 12 repetitions, try to increase the weight by 3-5lbs.
- Exercises include: leg extensions, calf raises, leg curls, chest press, latissimus pulldown, overhead press, row machine and curl ups.
- Your provider can refer you to a physical therapist or a physical medicine and rehabilitation physician for more guidance regarding bone-strengthening exercises.
- Decrease or stop caffeine intake.
- Quit smoking. Learn more about how to get started on OncoLink.
- Your provider may order a DEXA scan, which is a test used to measure the thickness (density) of your bones.
Heart Health, Muscle Loss & Weight Gain
- Maintain a healthy weight through diet and exercise. You can use online calculators to determine your body mass index (BMI), a measure of body fat. Aim for a BMI of 18.5-24.9. A BMI above 25 is considered overweight and a BMI above 30 is obese.
- Tips for a heart healthy diet:
- Have a diet high in fruits and vegetables. Eat unrefined whole grains, fat-free or low-fat dairy and lean meats and fish.
- Avoid processed foods, foods high in trans-fats, cholesterol and sodium, red meats, sugary drinks, soda and alcohol.
- Your healthcare provider or a dietitian can provide you with additional information about a heart healthy diet.
- Good resources for dietary information: American Institute for Cancer Research and www.myplate.gov
- Engage in regular weight bearing and muscle strengthening exercises as described above. Discuss with your healthcare provider before starting an exercise regimen. Start with what is comfortable for you and work up to the recommended amounts.
- Engage in regular aerobic exercise 3 times a week for 30 minutes.
- Always start with a 5-minute warm up.
- The goal of aerobic exercise is to increase your heart rate and break a sweat. To determine how high you should get your heart rate, first calculate your maximum heart rate (220-your age). In general, getting your heart rate to 50-65% of the maximum will cause you to sweat. If your rate is below 50% of the maximum, you should work harder. If it is above 65% of the maximum, you may want to slow down. If you are just starting to exercise, you should start at a low intensity such as 40-50% of your maximum heart rate. Learn more about aerobic exercise on OncoLink.
- Examples of good aerobic exercises include: walking, using a treadmill, cycling, elliptical trainer, and swimming.
- Your provider can refer you to a physical therapist or a physical medicine and rehabilitation physician for more guidance
- See your primary care provider at least once a year to monitor blood pressure, blood sugar (glucose and Hemoglobin A1C), and cholesterol.
- Go to the nearest emergency room if you experience chest pain, shortness of breath or lightheadedness.
- Decrease or eliminate caffeine, hot beverages / food, alcohol (particularly red wine), and spicy foods and reduce stress.
- Keep your bedroom cool.
- Dress in layers and wear cotton or lightweight, breathable fabrics.
- If you are taking Lexapro, Effexor, Zoloft, or Paxil, call your healthcare provider if you are having difficulty sleeping, dry mouth, nervousness or tremors in your hands. Call immediately if you have feelings of depression or thoughts of suicide.
- If you are taking Megace, call your healthcare provider if you feel you are retaining fluid (puffy hands, feet, ankles or gaining weight).
American Cancer Society. (2018, July) Hormone Therapy for Prostate Cancer. Retrieved from https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html
NIH Osteoporosis and Related Bone Diseases National Resource Center. What prostate cancer survivors need to know about osteoporosis. April 2016. Retrieved from http://www.niams.nih.gov/health_info/bone/osteoporosis/conditions_behaviors/osteoporosis_prostate_cancer.asp
Society for Endocrinology. Exercise improves quality of life in androgen deprivation therapy-treated prostate cancer: systemic review of randomized controlled trials. Nov 2015. Retrieved from http://erc.endocrinologyjournals.org/content/23/2/101.full.pdf+html