Androgen deprivation therapy (ADT) can reduce levels of male sex hormones in your blood that prostate cancer cells use to grow. It can potentially help cure or control your prostate cancer.

Prostate cancers that require androgen hormones to grow are called androgen-dependent or hormone-sensitive cancers. Doctors administer ADT, also called hormone-blocking therapy, to help shrink these cancers. ADT is often combined with other cancer treatments like chemotherapy or radiation therapy.

ADT can come in two different forms, surgical or medical. It may involve taking medications or removing your testicles surgically. The goal of ADT may be to help cure your prostate cancer or to help slow its growth if the cancer has spread to distant body parts and isn’t considered curable.

We examine how ADT is used to treat prostate cancer and what types of ADT are available.

ADT works by lowering the level of androgen hormones in your body. The main androgen hormones are testosterone and dihydrotestosterone (DHT). Most of these hormones are produced by your testicles with a small amount also produced by your adrenal glands and prostate gland.

You may receive ADT:

  • along with radiation therapy as your first-line treatment for prostate cancer
  • before radiation therapy to shrink your cancer or make radiation therapy more effective
  • if cancer comes back after treatment with radiation therapy or surgery
  • to help improve survival if your cancer has spread too far to be cured with radiation therapy or surgery

Several different types of hormone-blocking therapy can help lower androgens in your body. ADT types include:

  • Orchiectomy (surgical castration): Orchiectomy is the surgical removal of your testicles. It’s often the least expensive and simplest type of hormone-blocking therapy, but it’s permanent.
  • Luteinizing hormone-releasing hormone (LHRH) agonists: LHRH agonists work by decreasing the amount of testosterone produced by your testicles. These drugs are injected under your skin or inserted as implants once a month to every 6 months. Drugs in this class include:
    • leuprolide (Lupron or Eligard) and leuprolide mesylate (Camcevi)
    • goserelin (Zoladex)
    • triptorelin (Trelstar)
  • LHRH antagonists: LHRH antagonists are used to treat advanced prostate cancer in a slightly different way than LHRH agonists. These drugs include:
    • degarelix (Firmagon) administered as a monthly injection
    • relugolix (Orgovyx) administered as a daily pill
  • Drugs that block androgens made by other body parts: Drugs that can help block androgen production from your adrenal glands and prostate cells include:
    • abiraterone (Zytiga)
    • ketoconazole (Nizoral)
  • Anti-androgens: Anti-androgens work by blocking androgen receptors and the action of androgen hormones. These drugs include:
    • futamide (Eulexin)
    • bicalutamide (Casodex)
    • nilutamide (Nilandron)
    • nzalutamide (Xtandi)
    • apalutamide (Erleada)
    • darolutamide (Nubeqa

ADT can cause many side effects, including:

ADT is used as part of treatment plans for up to 40% of males with prostate cancer and has been part of the standard treatment of prostate cancer for many years. Canadian American doctor Charles Brenton Huggins won the Nobel Prize in 1966 for its development.

Hormone-blocking therapy alone doesn’t cure prostate cancer, but a 2021 study notes its inclusion in treatment is often associated with excellent cancer control outcomes when combined with chemotherapy, radiation therapy, or immunotherapy. However, the therapy can lead to adverse cardiometabolic effects that require management.

ADT is most often delivered through medications rather than surgery since the side effects are usually temporary instead of permanent. It might be administered as:

  • skin injections
  • implants
  • oral medications

If you’re receiving ADT medications, you likely won’t need to do anything particular to prepare. If you’re receiving an orchiectomy, your doctor will want to order tests to make sure your overall health makes you a suitable candidate for surgery.

You may be able to go home the same day as your procedure if you receive an orchiectomy. Discomfort around your scrotum may last for about a week. Cancer Research UK reports that most people can return to work after about 2 weeks, but you may need to wait a month before starting heavy lifting.

Most men who receive hormone-blocking therapy medications see their testosterone levels eventually return to normal with time. The time it takes for your testosterone levels to bounce back can vary widely. Studies have reported average times ranging from 4 to 18 months.

There are eight standard treatments for prostate cancer:

The cost of ADT and overall prostate cancer treatment can vary significantly based on factors, such as:

  • your geographic location
  • your treatment type
  • your treatment duration
  • the stage of your cancer
  • whether your cancer comes back

In a 2021 study, researchers found adding hormone-blocking therapy to radiation therapy increased the median survival of people with advanced prostate cancer by 0.71 years. This therapy addition brought the treatment cost to $17,384 for the first year and $23,488 for the 5 years after diagnosis.

Here are some frequently asked questions people have about ADT for prostate cancer.

How long does ADT last for prostate cancer?

Cancer Research UK reports that doctors often recommend ADT durations anywhere from 4 months to 3 years. The optimal duration can depend on factors such as how likely your cancer is to return and whether you develop side effects.

How long will you live with hormone therapy for prostate cancer?

Hormone-blocking therapy alone isn’t enough to cure prostate cancer. It can help cure your cancer when combined with other treatments or help extend your life if your cancer isn’t considered curable.

What happens when ADT treatment for prostate cancer stops working?

If hormone-blocking therapy stops working, your doctor may recommend the following alternative treatments, depending on how much the cancer has spread:

  • oral medications to block androgen receptors
  • radiation therapy
  • chemotherapy
  • immunotherapy

ADT is a common treatment for prostate cancer. It works by blocking the male sex hormones that prostate cancer cells need to grow. ADT is used to treat all stages of prostate cancer either by itself or combined with other treatments like chemotherapy or radiation therapy.

Your doctor can best advise you on whether you’re a candidate for ADT. They can also advise you about the potential side effects and costs.