The psychological impact of androgen deprivation therapy (ADT) in prostate cancer

By Dr Kenneth Gannon and Dr John Barry

Prostate cancer is the most common type of cancer in men and has become the third most common cause of cancer death in the UK, with almost 12,000 men dying from it every year (Prostate Cancer UK, 2018), slightly more than the number of women who die from breast cancer. Compared to White men, African Caribbean men are three times more likely to develop the disease and tend to do so at a younger age and in a more aggressive form.

Similarly to estrogen in some types of breast cancer, testosterone is associated with the development and course of prostate cancer. Androgen Deprivation Therapy (ADT) is a commonly used treatment for advanced prostate cancer, although it may also be used to treat disease confined to the prostate. Up to 50% of men being treated for prostate cancer may receive ADT.  It reduces symptoms and increases survival times by stopping testosterone production (Connolly et al, 2012). However this causes a range of serious side effects, including erectile dysfunction, genital shrinkage, loss of libido, hot flashes, osteoporosis, loss of muscle mass, breast enlargement, anaemia, fatigue, risk of diabetes, risk of cardiovascular disease and of potentially fatal cardiac events (Holzbeierlein, Castle & Thrasherl, 2004; Thompson, Shanafelt, Loprinzi 2003). ADT has also been linked with an increased risk of developing some types of dementias, though findings are inconsistent and the increased risk appears to be small.

ADT can impact mental health too. For example, it may increase mood swings (Cary, Singla, Cowan, Carroll, Cooperberg, 2014) and tearfulness (Ng, Woo, Turner, Leong, Jackson and Spry, 2012).  Depression may also occur as a result of testosterone reduction and the associated problems (Lee, Jim, Fishman, et al., 2015).

Understandably, some of these physical and mental symptoms can impact a man’s sense of his masculinity (Oliffe, 2006). Compared to patients having what might sound like more radical treatments (e.g. prostatectomy or radiotherapy), patients on therapy with hormones have relatively low HRQoL scores (Bacon et al, 2001).

Not all studies are in agreement (perhaps due to differences in methodology), but there is evidence that ADT is also linked to impairment to executive cognitive functioning, causing problems in planning, initiating and sequencing goal-directed behaviours, and memory issues. Further research is required on this issue. There is also some evidence that because of the reduction in testosterone, men on ADT perform less well in spatial cognitive abilities (Cherrier, Aubin & Higano, 2009).

In conclusion, prostate cancer treatment with ADT has a range of psychological implications for men and their partners. Some of these implications are in need of further research, especially treatment-related decision making, survivorship and the experiences of men from ethnic and sexual minorities.

If you have concerns about prostate cancer, contact https://www.prostatecanceruk.org/

About the authors

Dr Kenneth Gannon is the Clinical Research Director and Research Degree Leader at the University of East London. His chapter ‘Men’s Health and Cancer—The Case of Prostate Cancer’ covers various topics, including sexuality and ethnicity, and appears in the new book The Palgrave Handbook of Male Psychology and Mental Health

Dr John Barry is a Chartered Psychologist and co-founder of the Male Psychology Network and Male Psychology Section of the British Psychological Society. He is one of the editors of, and contributors to, The Palgrave Handbook of Male Psychology and Mental Health. https://doi.org/10.1007/978-3-030-04384-1

From the back cover of the Handbook of Male Psychology:

“This handbook brings together experts from across the world to discuss men’s mental health, from prenatal development, through childhood, adolescence, and fatherhood. Men and masculinity are explored from multiple perspectives including evolutionary, cross-cultural, cognitive, biological, developmental, and existential viewpoints, with a focus on practical suggestions and demonstrations of successful clinical work with men”.

References
Bacon, C. G., Giovannucci, E., Testa, M., & Kawachi, I. (2001). The impact of cancer treatment on quality of life outcomes for patients with localized prostate cancer. The Journal of urology, 166(5), 1804-1810.

Cary, K.C., Singla, N., Cowan, J.E., Carroll, P.R., and Cooperberg, M.R. (2014). Impact of androgen deprivation therapy on mental and emotional well being in men with prostate cancer: analysis from the CaPSURE registry. Journal of Urology, 191, 964-970.

Cherrier, M. M., Aubin, S., & Higano, C. S. (2009). Cognitive and mood changes in men undergoing intermittent combined androgen blockade for non‐metastatic prostate cancer. Psycho‐Oncology, 18(3), 237-247.

Connolly, R.M, Carducci, M.A. & Antonarakis, E.S., (2012) Use of androgen deprivation therapy in prostate cancer: indications and prevalence. Asian Journal of Andrology 14:2, 177-186

Holzbeierlein, J.M., Castle, E. & Thrasher, J.B. (2004). Complications of androgen

Lee, M., Jim, H.S., Fishman, M., et al. (2015). Depressive symptomatology in
men receiving androgen deprivation therapy for prostate cancer: a controlled comparison. Psychooncology, 24, 472-477.

Ng, E., Woo, H.H., Turner, S., Leong, E., Jackson, M. and Spry N. (2012). The influence of testosterone suppression and recovery on sexual function in men with prostate cancer: observations from a prospective study in men undergoing intermittent androgen suppression. Journal of Urology, 187, 2162-2166.

Oliffe, J. (2006). Embodied masculinity and androgen deprivation therapy. Sociology of Health and Illness, 28, 410-432.

Prostate Cancer UK (2018). We call on UK to step up as new figures show prostate cancer now a bigger killer than breast cancer. Accessed online 7th May 2018 on the internet [here]

Soloway, C. T., Soloway, M. S., Kim, S. S., & Kava, B. R. (2005). Sexual, psychological and dyadic qualities of the prostate cancer ‘couple’. BJU international, 95(6), 780-785.

Thompson CA, Shanafelt TD, Loprinzi CL (2003) Andropause: symptom management for prostate cancer patients treated with hormonal ablation. Oncologist, 8, 474-487

 

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