Androgen deprivation therapy (ADT) is the main therapeutic approach for men with metastatic prostate cancer. ADT is also frequently used in patients whose only manifestation of disseminated disease is a rising or elevated serum PSA and as an adjuvant or neoadjuvant in conjunction with initial treatment of men with intermediate or high risk prostate cancer. (See "Initial hormone therapy for metastatic prostate cancer" and "Initial management of regionally localized intermediate and high-risk prostate cancer" and "Rising serum PSA after treatment for localized prostate cancer: Systemic therapy".)
Despite the potential benefits associated with its use, ADT can cause a range of side effects that negatively affect quality of life. The side effects of hormone therapy for prostate cancer and their prevention and management are discussed here.
The vast majority of men receiving continuous ADT who are potent prior to therapy develop sexual dysfunction. Loss of libido in men receiving GnRH agonists usually develops within the first several months, and erectile dysfunction follows. Sexual dysfunction should be anticipated and couples counseled before ADT is started. Sex therapists may be helpful in managing these issues once they become problematic.
Recovery of erectile function is possible after discontinuation of short-term ADT (eg, in men who receive neoadjuvant and adjuvant ADT with radiation therapy for high-risk localized or locally advanced disease). However, it may be delayed and incomplete .
Alternative hormone strategies — Because one of the major disadvantages of ADT is sexual dysfunction, efforts have focused on the development of alternative hormone strategies that may permit sexually active men to retain potency.