Throw us a bone

by Donna Canada, RN, CURN

Androgen Deprivation Therapy (ADT), or hormone therapy, for prostate cancer lowers the testosterone level. Side effects from ADT can impact a person's Quality of Life (QOL). As a point of interest, the testosterone level goes up immediately after radical prostatectomy.

A Johns Hopkins study found that the pituitary gland makes more luteinizing hormone (LH), which regulates testosterone production. This occurs right after prostate surgery and its effect is not noticeable.²⁴

Common Side Effects of ADT

Some of the more common side effects of ADT are listed here with suggestions to alleviate or reduce them:

• Anemia
  Anemia occurs in the first few months after treatment in 90% of men. Most men do not require treatment because the reduction in red blood cell count is usually only about 10 percent. Performing weight lifting or resistance exercise can help to reduce the risk of developing anemia. A study from Australia showed that lifting weights just two to three times a week helps to stimulate red blood cell production in men on ADT.²⁵
  
  
• Cholesterol level changes
  Antiandrogen pills can lower HDL (good cholesterol) and increase triglycerides in some men. Whether or not ADT impacts the risks of heart disease is not well known, but this information reinforces the advice that prostate cancer patients know their cholesterol numbers as well as their PSA level. This makes sense in light of the fact that cardiovascular disease is the number one cause of death in men. Many lifestyle changes can help with cholesterol control such as a low-fat diet and daily exercise. Niacin is an excellent medication to increase HDL levels in men and taking fish oil can reduce triglycerides but keep in mind that all medications have some side effects. For example, niacin can cause hot flashes or liver problems and high doses of fish oil can cause a blood thinning effect with slowed blood clotting. Talk to your doctor about all of the options available to improve your cholesterol and lower your heart disease risk.²⁵
  
  
• Cognitive Impairment
  Decreased testosterone may cause an inability to remember some things and/or a feeling of mental fogginess or slowness. Mental exercises of all types help to keep the brain sharp. Reading, crossword puzzles, card games, and any other activity that requires the brain to exercise itself can help. Aerobic exercise also helps to keep the human blood vessels clean and to allow good blood flow to the brain. Some research suggests that fish oil or omega-3 fatty acids (EPA and DHA) and Vitamin D can help reduce the risk of cognitive impairment. New preliminary research shows that low doses of estrogen may also help prevent or treat this condition. Estrogen can also reduce bone loss in men on ADT, but it may increase the risk of a blood clot.²⁵
  
  
• Depression or mood changes
  It is good to discuss mental health before, during, and especially after prostate cancer treatment of any kind and seek help if it is needed. Heart healthy=mentally healthy. Research continues to show that exercise may prevent depression and, in those individuals on anti-depressant medication, it may improve the efficacy of the treatment. Weight lifting or resistance exercise also seems to reduce the risk of depression. Some dietary supplements such as SAM-e (S-adenosylmethoinine) have been combined with prescription medication in some instances with good result. Omega-3-fatty acids or fish oil pills also have good results in research studies. An herb knows as St. John's Wort is often recommended for depression. Moyad states" I strongly advise prostate cancer patients to stay away from this herbal product because it has been shown to reduce the effectiveness of many medications, including some cancer drugs" (Moyad). A variety of prescription medications for depression are also available to discuss with your doctor.²⁵
  
  
• Penis/scrotum shrinkage (atrophy) or genital Atrophy
  Several nerve bundles run alongside the prostate and help to control erections. If any of them is injured or becomes less active, the penis and scrotum receive less stimulation, which can result in a small change in length and/or width of the penis. In addition, male hormone helps maintain the size of the genital area so when testosterone is reduced, the penis and scrotum may also be reduced in size.
   
• Breast pain and enlargement
  One method to prevent breast pain and enlargement is to take a daily anti-estrogen prescription pill such as tamoxifen or any aromatase inhibitor. These drugs work by blocking the ability of estrogen to stimulate the breast tissue in men. The other effective method of prevention is to receive a small dose of radiation to each breast (known as "prophylactic breast irradiation"). This "quick fix" usually only needs to be done once.²⁵
  
  
• Hot flashes
  The frequency and severity of hot flashes vary dramatically from one individual to another. For most mild to moderate hot flashes, a prescription drug is not required. For moderate to severe hot flashes, however, a prescription drug can be very helpful. Researchers have learned from studies of women going through menopause that lifestyle changes may play a large role in the management of hot flashes. Before discussing treatment for your hot flashes, you need to determine their frequency and severity.

Mark Moyad, M.D. has the following recommendations for addressing hot flashes:
 

Promoting Wellness for Prostate Cancer Patients, Third Edition, Mark A. Moyad, MD, MPH
Spry Publishing, 877-722-2264, sprypub.com

Promoting Wellness for Prostate Cancer Patients, Third Edition, Mark A. Moyad, MD, MPH
Spry Publishing, 877-722-2264, sprypub.com

Promoting Wellness for Prostate Cancer Patients, Third Edition, Mark A. Moyad, MD, MPH
Spry Publishing, 877-722-2264, sprypub.com

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This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted June 2011