NCCN Guidelines for Patients® | Prostate Cancer - page 36

36
NCCN Guidelines for Patients
®
: Prostate Cancer
Version 1.2014
Part 4: Overview of cancer treatments
Estrogens
can stop the adrenal glands and
other tissues from making testosterone. DES
(
d
i
e
thyl
s
tilbestrol) is a commonly used estrogen.
Corticosteroids
can stop the adrenal glands and
other tissues from making testosterone.
Androgen synthesis inhibitors
are drugs that
block the making of androgen at different sites.
Ketoconazole is an antifungal drug that stops the
adrenal glands and other tissues from making
testosterone. Abiraterone acetate works similarly but
is more potent and less toxic.
Sometimes, antiandrogens are used with LHRH agonists
or following an orchiectomy. This type of ADT is called
CAB (
c
ombined
a
ndrogen
b
lockade). However, CAB is
no better than castration alone for metastases. Moreover,
it may lead to higher costs and worse side effects.
Finasteride or dutasteride used with CAB is called triple
androgen blockade. The benefit of triple androgen
blockade is probably small if any benefit exists.
If you will be on long-term ADT, your doctor may consider
intermittent therapy to reduce side effects. Intermittent
therapy is alternating periods of time on and off ADT.
Intermittent therapy can provide similar cancer control to
continuous ADT.
ADT has multiple side effects. It can disrupt sexual
functioning by decreasing your desire for sex and causing
erectile dysfunction. These sexual side effects don’t seem
to lessen with time. The longer you take ADT, the more
your risk for osteoporosis, bone fractures, obesity, loss
of muscle mass, diabetes, and heart disease increases.
Most men have hot flashes but these may decrease over
time. You may have breast tenderness and growth of
breast tissue if you take antiandrogens or estrogens.
Not all of the side effects of ADT are listed here. Please
ask your treatment team for a complete list of common
and rare side effects. If a side effect bothers you, tell
your treatment team. There may be ways to help you feel
better.
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