The non-sexual sequelae of ADT include the reduction of insulin sensitivity, an increased risk of diabetes, cardiovascular events, bone density loss, and increased mortality.
What are the long-term effects of ADT?
There are serious side effects with long-term ADT – things that testosterone normally helps protect you from – including thinning of bones, loss of muscle mass, weight gain, loss of libido, hot flashes, mood changes, depression and, our main subject here, the risk of cognitive impairment.
How long does it take to recover from TT after ADT?
Baseline TT levels under 400 ng/dL and ADT duration greater than six months were associated with a lower likelihood of recovery to normal TT at 24 months.
When is ADT therapy the right thing to do?
There are very few specific situations when ADT therapy is the right thing to do. These are the most common: * Intermediate-risk men who are given six months of ADT plus external-beam radiation; * High-risk men who are getting radiation therapy .
What should I know before taking ADT?
•Be proactive : do complete medical, psych history, physical and blood work prior to initiation of ADT as a baseline to identify pre-existing problems (eg hyperlipidemia, glucose intolerance, past depression) and for comparison over time
What happens when you stop androgen deprivation therapy?
Most of the sexual and emotional side effects caused by low levels of androgens will eventually go away if a man stops taking hormone therapy. However, particularly for older men and those who received ADT for a long time, testosterone levels may not fully recover and these side effects may not disappear completely.
How long is ADT effective for prostate cancer?
In localized and locally advanced prostate cancer, ADT is typically combined with radiotherapy (RT) to the prostate area. Patients typically receive ADT for two to three years, based on previous clinical trials that established that long-term ADT (28-36 months) is more effective than short term ADT (4-6 months).
How quickly does PSA drop after hormone therapy?
Median PSA at the end of hormonal therapy for all patients was 0.2 ng/mL (range: 0 - 96.2). A total of 744 patients (70%) reached a PSA-CR at the end of hormonal therapy. The time to reach PSA nadir was 3.7 months, ranging from 0.8 to 8.2 months. With a median follow-up of 7.2 years, higher rates of BF (56% vs.
How long does it take for testosterone to return to normal after Lupron?
Conclusion: After LHRHa treatment and radiotherapy, the testosterone levels of most men had recovered to normal by 18-24 weeks after the last LHRHa injection.
Does testosterone return after ADT?
After ADT, many patients had normal testosterone levels (>6 nmol/L) until 6 weeks, and testosterone recovery reached 35% at 12 weeks (mean, 11.4 nmol/L), 85% at 18 weeks, and 89% at 24 weeks. The median time for testosterone recovery was 13 weeks.
How long can a man stay on hormone therapy for prostate cancer?
It is often given for intermediate-risk cancer for 4 to 6 months (called short-term hormone therapy), and for 2 to 3 years in men with high-risk localized prostate cancer, although some doctors may recommend as little as 18 months of hormone therapy.
What is normal PSA after hormone therapy?
Recent studies have shown that for optimal results, PSA levels should be lower than 1 ng/ml, and even lower than 0.5 ng/ml.
What happens to the prostate after radiation therapy?
Radiotherapy to the prostate can cause some side effects, such as loose or watery poo (diarrhoea) and passing wee (urine) more often. Side effects tend to start a week or 2 after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends.
What is the average PSA for a 70 year old?
3.5-4.5: Normal for a man 60-70 yrs. 4.5-5.5: Normal for a man 70-80 yrs.
What happens after stopping Lupron?
If Lupron treatment is stopped, testosterone levels can rise and your cancer may worsen. Do not discontinue Lupron Depot unless your doctor tells you to stop treatment. In men, testosterone is reduced to castrate concentrations with Lupron Depot treatment.
What happens when Lupron treatment is over?
When a person first starts treatment with Lupron, they may have a testosterone flare. Later on, they may experience side effects due to having very low testosterone levels in their body. After treatment stops, testosterone levels begin to return to normal.
Are the effects of Lupron permanent?
Lupron Depot side effects are almost always reversible and will go away after treatment is complete.
What is ADT therapy?
ADT: What You Really Need to Know. The only people who really like androgen deprivation therapy (also called ADT, or hormonal therapy) are the drug companies that make billions of dollars a year selling the drugs. Doctors don’t like it, and men don’t like being on these drugs. So why do it?
Who should not get ADT?
Who should not get ADT? Anybody else with prostate cancer. If you just have a rising PSA after radiation therapy or radical prostatectomy, that is not a good enough reason for a doctor to put you on ADT. If your doctor wants to put you on ADT to “shrink your prostate” before brachytherapy, that’s not a good enough reason .
What is ADT in menopause?
Androgen Deprivation Therapy (ADT) causes andropause. It’s like menopause, but it’s the male version. Male hormones including testosterone are called androgens, and ADT basically shuts down all of those hormones.
How many calories does ADT burn?
A man on ADT who wants to lose that same pound needs to burn 4,500 calories. He’s slogging upstream with ankle weights. His metabolism is slower, his sugar metabolism is messed up, his blood pressure may be higher, and for many reasons, he probably feels like crap. Maybe he stops taking care of himself.
Why do some men on ADT have cognitive impairment?
The metabolic syndrome that ADT causes may be a major reason – nobody knows for certain yet – why some men who are on ADT have cognitive impairment.
How to prevent weight gain from ADT?
It’s also something you can help prevent . You need to exercise, with cardio (walking, swimming, riding a bike, aerobics, jogging, etc.,) plus weights for strength. These can be light weights; you don’t need to turn into Arnold Schwarzenegger and bench-press a Volkswagon Beetle or anything like that. You just need to keep your muscles working. Exercise will help with depression, with the cardiac risks, and with the risk to your brain. As University of Colorado radiation oncologist E. David Crawford, M.D., recently put it, “What’s heart healthy is usually prostate-cancer healthy… I’ve got a number of (patients on ADT) who are in great shape and they’re tolerating [treatment] quite well. These are the people who are out there, who continue to lift weights, they continue to exercise, they watch their diet.”
What to do if your PSA is rising?
These include: Salvage surgery or radiation, if your doctor thinks the cancer is still confined to the “prostate bed,” the area around the prostate.
What are the benefits of ADT?
Here are some really important facts that are worth remembering about the use of ADT: 1 It is very, very effective at ameliorating the bone pain associated with late-stage, metastatic prostate cancer (as initially demonstrated by Huggins and Hodges some 75 years ago). 2 Because it suppresses the normal levels of testosterone in men, it is associated with a whole series of serious adverse side effects that can vary in intensity from patient to patient and which include loss of libido, loss of erectile function, weight gain, changes in body form, gynecomastia, and effects on mental capabilities over time. 3 If there is a survival benefit associated with ADT, it is small, and may only be evident in a subset of patients (who we are currently unable to define in advance). 4 Early initiation of ADT introduces significant risk for early induction of the development of androgen-resistant prostate cancer cells, which has the potential to lead to early onset of metastatic, castration-resistant prostate cancer. 5 Overly early initiation of ADT may therefore mean that ADT never gets the chance to be used to do the one thing we know that it is really good at — ameliorating the bone pain associated with metastatic disease!
What to ask a doctor about ADT?
For patients facing ADT, I recommend asking what the doctor knows about side effects and countermeasures. If the doctor does not seem savvy, it might be a fine idea to find another doctor who knows this territory.
What is ADT used for?
Once upon a time — and not so long ago — we had nothing else at all, other than ADT, with which to treat advancing forms of prostate cancer that had progressed after treatment with surgery and/or radiation therapy. As a consequence, ADT started to be used to “manage” patients’ rising PSA levels.
Can you start ADT with prostate cancer?
There are good reasons why many experts in the management of prostate cancer advise their patients with progressive disease not to start treatment with ADT just because their PSA is rising, but to start ADT only if and when there are other good reasons to do so, such as a PSA doubling time of 9 months or less, or a PSA level that has risen to 50 ng/ml and/or evidence of metastatic disease (even if there is no actual pain associated with the metastasis).
Can abiraterone acetate be used for prostate cancer?
Frankly, it is no longer clear that this is possible at all, given the development of effective second-line treatments like abiraterone acetate and enzalutamide that clearly do extend the survival of men with metastatic, castration-resistant prostate cancer. The trials that would be needed today to resolve the two questions would have to be very large, very highly controlled, requiring multiple trial arms, and might take as long as 15 to 20 years to carry out! The costs would be enormous; the advancement in knowledge would likely be small; and by the time the trials were completed, we might well find that the results were irrelevant given other advances in the management of advanced prostate cancer.
Is ADT good for metastatic disease?
Overly early initiation of ADT may therefore mean that ADT never gets the chance to be used to do the one thing we know that it is really good at — ameliorating the bone pain associated with metastatic disease!
Is ADT a standard protocol?
Allan’s description of the role of ADT in SRT is mine too. It is not a standard protocol but needs to be assessed and discussed on a case by case basis — and it is rarely an easy decision.
Why is ADT used in combination with radiation therapy?
Although ADT has always played an important role in men with advanced metastatic prostate cancer, it is also increasingly being used in combination with radiation therapy because studies have shown that this combination increases long-term survival.
How long does it take for a prostate to heal?
It is often given for intermediate-risk cancer for 4 to 6 months (called short-term hormone therapy), and for 2 to 3 years in men with high-risk localized prostate cancer, although some doctors may recommend as little as 18 months of hormone therapy. Hormone therapy should not be given to men with low-risk prostate cancer ...
How long does radiation therapy help with prostate cancer?
It is often given for intermediate-risk cancer for 4 to 6 months ...
Does ADT help with prostate cancer?
ADT is designed to either stop testosterone from being produced or to directly block it from acting on prostate cancer cells. Although hormone therapy is effective at controlling prostate cancer growth, the loss of testosterone has side effects in nearly all men. These side effects range from hot flashes and loss of bone density to mood swings, ...
Can hormone therapy be given with radiation?
Hormone therapy is often given together with radiation therapy for localized disease (note: it is also used alone or in combination with other treatments for men with metastatic prostate cancer).
How long are patients followed after LHRH injection?
All patients were followed for 15 months after the last injection of their LHRH antagonist
When does serum T level go back up?
Most patients will see their serum T levels rise back up into the “normal” spectrum at 18 months after initiation of treatment, but …. No one seems to be suggesting that (at least within 18 months) patients should expect to recover the same level of serum T after even a short course of ADT as the level they had before their ADT.
How long does it take for testosterone to normalize after LHRH?
In most patients, the testosterone level had normalized within 9 months after the last LHRH administration. Sexual and hormonal function recovered after short-term LHRH antagonist administration for neoadjuvant therapy before EBRT.
How long does it take to recover from LHRH?
The median time to recovery of a “normal” serum T level (i.e., > 7.2 nmol/l or 207 ng/ml) was 7 months after the last LHRH antagonist administration.
Is neoadjuvant ADT necessary?
The role of neoadjuvant ADT in combination therapy for intermediate-risk prostate cancer should probably be confined to those for whom it is essential (to whatever extent it is possible to define that necessity).
What is ADT treatment?
ADT -- which turns off production of the male hormone testosterone that fuels the growth of prostate tumors -- is a first line of treatment for metastatic disease (that has spread beyond the prostate).
Why do men take a break from hormone therapy?
Many men take a break from hormone therapy -- aka androgen-deprivation therapy or ADT -- to lessen its often debilitating side effects. ADT -- which turns off production of the male hormone testosterone that fuels the growth of prostate tumors -- is a first line of treatment for metastatic disease (that has spread beyond the prostate).
How long did men stay on Zoladex?
All were given androgen deprivation therapy with Zoladex and Casodex for seven months . Men who responded were divided into two groups, with one staying on continuous ADT and the other getting intermittent treatment. They were tracked for an average of more than nine years.
Does hormone therapy cause hot flashes?
But because hormone therapy blocks male hormones, it can lead to loss of sexual function and severe hot flashes. Over time, weakened bones (osteoporosis) and heart problems may develop.
Is ADT interrupted an initial treatment?
Interrupted ADT should no longer be recommended as an initial treatment, says researcher Maha Hussain, MD, of the University of Michigan Comprehensive Cancer Center in Ann Arbor, Mich.
Can hormone therapy shorten the life of men with prostate cancer?
June 4, 2012 (Chicago) -- Taking a break from hormone therapy can shorten the lives of some men with metastatic prostate cancer, researchers say.
