Many men undergo androgen deprivation therapy (ADT) as part of their prostate cancer treatment. But even two years after ADT ends, patients may still struggle with low testosterone, according a recent report.
The term androgens refer to male hormones like testosterone. This hormone is important for men’s health, but it can also fuel the growth of prostate cancer cells. ADT reduces the amount of testosterone in a man’s body, cutting off the cancer’s power supply.
ADT is more common in men with intermediate- and high-risk prostate cancer as well as men whose cancer has spread beyond the prostate gland.
Decreasing testosterone in this way has its drawbacks, however. Low testosterone is linked to lower bone density, leaving men at higher risk for osteoporosis. Men with low testosterone are also more likely to develop diabetes and heart disease.
There are sexual side effects as well, including diminished libido, orgasm difficulties, and erectile dysfunction.
Researchers investigated this issue in a recent Journal of Sexual Medicine study. They collected data from 307 men who underwent ADT. The men’s average age was 65 years, and they had spent an average of 17 months on ADT.
The research team took note of the men’s testosterone levels at baseline (before they started ADT) and 24 months after the men finished ADT.
Total testosterone is measured in nanograms per deciliter (ng/dL). For this study, a measurement above 300 ng/dL was considered normal. Castrate level was defined as a measurement less than 50 ng/dL.
The men’s average baseline testosterone was 379 ng/dL. Twenty-four months after ADT finished, 8% of the men were still at castrate level. For 76% of the men, testosterone levels had returned to normal, and 51% of the men saw their levels return to baseline.
Recovery to normal levels was less likely for men who had baseline levels below 400 ng/dL and those who had ADT for over six months. Recovery occurred more slowly for men over age 65 and those who had been on ADT for longer durations.
The study authors recommended that doctors talk to their prostate cancer patients about testosterone levels before ADT begins, noting that “it is still difficult to estimate individualized chances of recovery.”
Resources
American Cancer Society
“Hormone Therapy for Prostate Cancer”
(Last revised: July 18, 2018)
https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html
The Journal of Sexual Medicine
Nascimento, Bruno MD, et al.
“Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer”
(Full-text. Published online: May 9, 2019)
https://www.jsm.jsexmed.org/article/S1743-6095(19)30735-0/fulltext
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