Androgen Deprivation Therapy remains one of the most effective treatments for controlling prostate cancer
Hormone therapy — more formally known as Androgen Deprivation Therapy (ADT) — is a cornerstone of prostate cancer management. In this newsletter, we’ll explore what ADT is, how it works, when it’s used, and what men can do to reduce and manage the side effects that can come with treatment.
What Is Androgen Deprivation Therapy (ADT)?
Prostate cancer depends on male hormones (androgens) — primarily testosterone — to grow and spread.
ADT works by lowering the amount of testosterone in the body or blocking its effect on prostate cancer cells.
In simple terms, ADT “starves” prostate cancer cells of the hormones they need to survive.
This can slow the cancer’s growth or even shrink it.
However, it’s important to note that ADT is not a cure for prostate cancer.
Rather, it is a disease control tool, used to either:
Delay the progression of the disease,
Improve the effectiveness of other treatments (like radiotherapy), or
Help manage advanced or recurrent cancer.
How Does ADT Work?
The goal of ADT is to reduce testosterone to very low (“castrate”) levels.
This can be achieved in several different ways:
1. Reducing Testosterone Production
Most testosterone is made by the testicles.
Certain medications act on the brain’s hormonal control system to stop the testicles from producing testosterone.
There are two main types of these medications:
LHRH (Luteinizing Hormone-Releasing Hormone) Agonists
These drugs first cause a short-lived increase in testosterone before switching it off.
Common examples include leuprolide (Lucrin®) and goserelin (Zoladex®).
They are given as injections every 1–6 months.LHRH Antagonists
These drugs block testosterone production immediately, without the initial hormone surge.
Examples include degarelix (Firmagon®) and the newer relugolix (Orgovyx®) (oral tablet).
2. Blocking Testosterone Action
Even with low testosterone, small amounts of the hormone can still be produced by the adrenal glands (small glands above the kidneys).
Drugs called androgen receptor blockers prevent testosterone from stimulating cancer cells.
Older examples include bicalutamide (Cosudex®).
Newer, more potent drugs include enzalutamide (Xtandi®), darolutamide (Nubeqa®), and apalutamide (Erleada®).
These may be used alone or in combination with other treatments.
When Do We Use ADT?
ADT can be used in several different clinical settings:
1. Advanced or Metastatic Prostate Cancer
For men whose prostate cancer has spread beyond the prostate, ADT is the mainstay of treatment.
It helps control cancer growth, ease symptoms, and prolong life.
In recent years, ADT is often combined with other agents (such as chemotherapy or advanced hormone blockers) for even better outcomes.
2. After Surgery or Radiotherapy (Recurrence)
Sometimes, prostate cancer returns after initial curative treatment — this is usually seen as a rising PSA.
In this case, ADT may be started to control the recurrence and slow further progression.
3. Before and During Radiotherapy
For men with localised but higher-risk prostate cancer (for example, Gleason 7 [4+3] or above, PSA >10, or palpable disease), ADT is given alongside radiotherapy to improve the chance of success.
It helps shrink the prostate and tumour before radiation.
It also sensitises cancer cells to the effects of radiation, improving control rates.
4. After Radiotherapy
Some men benefit from continuing ADT for 1–2 years after radiotherapy — known as adjuvant hormone therapy.
This approach reduces the risk of recurrence in men with aggressive disease features.
DO YOU HAVE A QUESTION?
Dr Chabert will be hosting a Q&A on Thursday 27th November 7:30pm AEST on his YouTube channel, covering everything you need to know about prostate health, treatments, surgery, recovery & more!
Become a premium subscriber - Don’t miss your chance to be heard.
Common Side Effects of ADT
Because ADT lowers testosterone — a hormone involved in energy, mood, muscle strength, bone density, and sexual function — side effects are common but vary in intensity between men.
Possible side effects include:
Hot flushes or “flashes”
Fatigue or low energy
Reduced libido (sex drive)
Erectile dysfunction
Weight gain (particularly around the abdomen)
Mood changes or “brain fog”
Loss of muscle mass and strength
Thinning of bones (osteopenia or osteoporosis)
Changes in cholesterol and blood sugar control
While these can sound daunting, it’s important to remember that many men tolerate ADT well and that there are effective strategies to manage or prevent most side effects.
Practical Tips to Reduce Side Effects
1. Stay Physically Active
Exercise is one of the most powerful tools for protecting your health during ADT.
Aim for at least 30 minutes of movement daily — even a walk outdoors can boost energy and mood.
Include resistance or weight training 2–3 times a week.
This helps to:Maintain and build muscle mass
Improve balance and strength (reducing risk of falls)
Support healthy metabolism and heart health
Protect bone density
Improve cognition and overall wellbeing
Research consistently shows that men who exercise regularly while on ADT experience fewer side effects and maintain a better quality of life.
2. Eat for Muscle and Metabolic Health
Your diet can strongly influence how your body responds to ADT.
Focus on high-protein foods: lean meats, fish, eggs, legumes, dairy, nuts, and tofu.
Protein supports muscle growth and repair.Minimise processed carbohydrates (such as white bread, pasta, sweets, and soft drinks).
Choose whole grains, fruits, and vegetables for fibre and nutrients.
Stay hydrated, and limit alcohol.
If you’re unsure about dietary changes, ask your GP or a dietitian for tailored advice.
3. Managing Hot Flushes
Hot flushes are one of the most common and frustrating side effects of ADT.
Tips that may help:
Keep cool and avoid hot environments when possible.
Limit hot drinks, coffee, and spicy foods, which can trigger flushing.
Some men find evening primrose oil or acupuncture helpful.
If severe, your doctor can review your ADT medication or prescribe additional treatments to reduce symptoms.
For men on intermittent ADT (having treatment breaks), your doctor may also try to time injections during cooler months if possible.
4. Protect Your Bones
Low testosterone can cause bone thinning over time.
To maintain strong bones:
Engage in resistance exercise and weight-bearing activities (walking, stair climbing, etc.).
Ensure adequate calcium and vitamin D intake.
Discuss having a DEXA scan to monitor bone mineral density.
Your doctor may also consider bone-strengthening medications if needed.
Emotional & Mental Wellbeing
Lower testosterone levels can sometimes affect mood, memory, and motivation.
These changes can be subtle or noticeable, especially during long-term therapy.
Stay socially connected — isolation can worsen fatigue and mood changes.
Engage in mentally stimulating activities (reading, puzzles, hobbies).
If you notice persistent low mood or brain fog, talk to your GP — support is available and effective.
Final Thoughts
Androgen Deprivation Therapy remains one of the most effective treatments for controlling prostate cancer.
While it can have side effects, knowledge, proactive lifestyle changes, and medical support can make a world of difference.
By staying active, eating well, protecting your bones, and keeping communication open with your care team, you can maintain both physical health and quality of life throughout treatment.
If you have questions, or would like to share your experience, we encourage you to reach out or comment — your story can help others navigate the same journey.