The psychological impact of androgen deprivation therapy (ADT) in prostate cancer
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, 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. 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. 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 and tearfulness. Depression may also occur as a result of testosterone reduction and the associated problems.
Understandably, some of these physical and mental symptoms can impact a man’s sense of his masculinity. 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.
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.
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.
This article was first published on the Male Psychology Network website in 2019.
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Dr Kenneth Gannon is the Clinical Research Director and Research Degree Leader at the University of East London. Ken presented his work at the 2015 Male Psychology Conference at University College London (UCL). His book chapter will appear in the forthcoming Handbook of Male Psychology: Theory and Practice (Palgrave Macmillan) in 2019. Contact here.
Dr John Barry is a Psychologist, researcher, clinical hypnotherapist & co-founder of the Male Psychology Network, BPS Male Psychology Section, and The Centre for Male Psychology. Also co-editor of the Palgrave Handbook of Male Psychology & Mental Health, and co-author of the new book Perspectives in Male Psychology: An Introduction (Wiley).