What are the long-term effects of Androgen Deprivation Therapy (ADT) when administered for six months versus one year?

From the Guidelines

Androgen deprivation therapy (ADT) for six months is generally recommended for intermediate-risk prostate cancer patients, while high-risk patients may require a longer course of ADT, typically 18 to 24 months, to minimize the risk of progression and death. The decision to extend ADT duration should be based on individual patient risk factors, including Grade Group 4 to 5 cancer, positive surgical margins, and higher PSA at the time of radiation therapy 1.

Key Considerations

• The longer duration of ADT is associated with more pronounced side effects, including bone density loss, metabolic changes, and cardiovascular effects 1.
• High-risk patients with adverse factors, such as Gleason score 8 to 10, may benefit from longer-term ADT, typically 2 to 3 years, in conjunction with aggressive local radiation 1.
• The recovery from ADT effects generally begins within 3-6 months after stopping treatment, with testosterone levels typically returning to baseline within 6-12 months 1.

Clinical Implications

• For patients with high-risk features, clinicians may extend ADT to 18 to 24 months, while for intermediate-risk patients, six months of ADT may provide adequate cancer control while minimizing side effects 1.
• The choice of ADT duration should be individualized based on patient risk factors, treatment goals, and potential side effects 1.
• The most recent evidence suggests that longer-term ADT is associated with improved disease-specific and overall survival in high-risk patients, supporting the use of extended ADT in this population 1.

From the Research

Long-term Effects of Androgen Deprivation Therapy (ADT)

The long-term effects of ADT can be significant, and it is essential to consider both the benefits and risks of this treatment [(2,3,4)].

• Side Effects: Common side effects of ADT include loss of libido, erectile dysfunction, hot flashes, gynecomastia, changes in body composition, and changes in lipids [(3,4)].
• Bone Health: ADT can lead to a loss of bone mineral density, increasing the risk of fractures [(2,4)].
• Cardiovascular Health: ADT may also increase the risk of cardiovascular morbidity and mortality 4.
• Metabolic Changes: ADT can lead to metabolic changes, including obesity, sarcopenia, lipid alterations, insulin resistance, and an increased risk of diabetes 4.

Duration of ADT and Side Effects

While the provided studies do not directly compare the long-term effects of ADT when administered for six months versus one year, they do suggest that even short-term use of ADT can lead to numerous side effects 4.

• Intermittent ADT: Intermittent ADT, in which patients receive cycles of ADT, may improve the tolerability of ADT and patients' quality of life, without compromising clinical outcomes [(2,5)].
• Management of Side Effects: Various strategies are available to manage the side effects of ADT, including lifestyle interventions, pharmacological interventions, and tailored treatment approaches [(2,3,5,6)].

Considerations for Clinicians

Clinicians should be aware of the potential long-term side effects of ADT and incorporate strategies for preventing and managing toxicities into routine practice [(2,3,4,5,6)].

• Patient Education: Patients should be informed about the potential side effects of ADT and the strategies available to manage them 4.
• Monitoring and Follow-up: Regular monitoring and follow-up are essential to identify and manage side effects early [(2,3,6)].