Definition and Mechanism
ADT is a treatment or procedure in which the androgen receptors of target cells are not activated, achieved through either:
- Reduction in testosterone production (castration via LHRH agonists/antagonists or surgical orchiectomy)
- Androgen receptor blockade (antiandrogen medications)
- Combinations of both approaches 1
The therapy encompasses castration therapies, antiandrogen therapies, and their combinations 1.
Clinical Context
ADT serves as the standard first-line systemic treatment for men with:
- Documented metastatic prostate cancer
- Recurrent androgen-sensitive prostate cancer
- Progressive disease where curative therapy is not feasible 1
The primary goal of ADT in these settings is palliation rather than cure 1.
Key Treatment Modalities
Medical castration options include:
- LHRH agonists (luteinizing hormone-releasing hormone agonists)
- LHRH antagonists (oral or injectable)
Surgical castration:
- Bilateral orchiectomy
Antiandrogen therapy:
- Steroidal antiandrogens
- Nonsteroidal antiandrogens (e.g., bicalutamide, flutamide, nilutamide)
LHRH agonists and bilateral orchiectomy are equally effective for achieving castration 2.
Important Clinical Considerations
ADT has substantial toxicity including osteoporosis, fractures, obesity, insulin resistance, lipid alterations, increased diabetes risk, and cardiovascular disease risk 2. These adverse effects necessitate shared decision-making between patients and physicians when considering ADT initiation 1.