The most common type of Androgen hormone is testosterone. Testosterone levels in the body can be lowered by removal of the testes, or using certain drugs to kill testicular function.
ADT is used to treat prostate cancer, including recurrent prostate cancer and metastatic prostate cancer. Metastatic prostate cancer is cancer cells that have spread throughout the body.
ADT also includes adjuvant therapy (advanced therapy) because it is administered after surgery for men who have cancer in the lymph nodes to remove remaining cancer cells and prevent coming back.
ADT is considered as adjuvant therapy if prostate cancer has been found in lymph nodes after radical prostatectomy given up to 3 years for high-risk and 6-month cancers for men with medium-risk cancers.
Androgen Therapy
Types of androgen therapy
1. Bilateral Orchiectomy.
Bilateral orchiectomy is the surgical removal of both testes and first used for the treatment of metastatic prostate.
ADT is considered an operation because it eliminates the main source of testosterone production, the testes. The effect of this operation is permanent and non-refundable.
2. LHRH Agonists.
LHRH (Luteinizing hormone-releasing hormone) is a testicular prevention drug receiving messages sent by the body to make testosterone.
By blocking these signals, LHRH agonists reduce a man's testosterone level and remove the functioning of the testicles.
However, unlike surgeon surgery, the LHRH agonist effect is reversible, so testosterone production usually begins again after the patient stops treatment.
3. LHRH antagonist
The drug is also called gonadotropin-releasing hormone (GnRH) antagonist, to stop the testes from producing testosterone like LHRH agonists, but they reduce testosterone levels faster and do not cause flares.
Flare is a condition where high testosterone levels turn into a very low drop suddenly.
One of the side effects of this drug is that it can cause severe allergic reactions.
4. Anti-androgen
Anti-androgens block testosterone utilizing the "androgen receptor," which is a chemical structure in cancer cells that allows testosterone and other male hormones to enter the cells.
This drug is used in men who have "hormone sensitive" prostate cancer, which means that prostate cancer still responds to ADT. Anti-androgens are usually not used alone in the treatment of prostate cancer.
5. Enzalutamide (Xtandi)
This drug is a new type of anti-androgen blocking signals from androgen receptors.
Enzalutamide is approved by the FDA for men who have developed progressive prostate metastatic cancer.
Treatment with enzalutamide has led to overall improved survival.
6. CYP17 Inhibitor.
Although testes are a major producer of testosterone, other cells in the body can still make small amounts of testosterone that can promote cancer growth. These include the adrenal glands and some of the prostate cancer cells themselves, the CYP17 inhibitor plays a role in preventing it.
Abiraterone acetate (Zytiga) is a drug that blocks enzymes called CYP17 Inhibitors and prevents these cells from making certain hormones, including adrenal androgens.
Abiraterone acetate can cause serious side effects such as high blood pressure, low blood potassium levels, and fluid retention. Other common side effects include weakness, joint swelling or pain, swelling in the legs or feet, reddening, diarrhea, vomiting, shortness of breath, and anemia.
Side effects of androgen therapy for prostate treatment
Androgen therapy causes side effects that generally disappear after treatment is completed, except in men who already have orchiectomy.
These side effects include:
- DE (erectile dysfunction)
- jaded, weak and lethargic
- Weight loss
- Loss of muscle mass
- Osteopenia or osteoporosis, or bone thinning
Another important side effect of androgen therapy is the risk of developing metabolic syndrome disease such as obesity, blood cholesterol levels and high blood pressure that increases a person's risk of heart disease, stroke, and diabetes.
The risks and benefits of androgen therapy should be discussed with your doctor. For men with metastatic prostate cancer. Side effects control management is very important for prostate cancer patients who receive androgen therapy treatment including regular exercise, do not smoke, healthy diet, take vitamin D or calcium supplements, and treatment as preventive cardiovascular follow-up.
