About Prostate Cancer

Prostate Cancer is the most common solid organ cancer in men in Australia, and affects 1 in 7 men over their lifetime. Most cases are low risk and do not lead to any long-term effects, however, there are many cases which require active treatment.

It is most often detected from a screening PSA (prostate specific antigen) blood test or digital rectal examination performed by your GP. A high PSA blood test may indicate prostate cancer (but doesn’t always) but it usually suggests the need for further monitoring or investigation with a biopsy. A biopsy performed by a urologist will be able to confirm whether there is prostate cancer present and also the severity, known as the Gleason Score.

What is a Gleason Score?

Gleason score levels or Gleason grade is a system of describing how severe prostate cancer looks under a microscope. Scores range from 2 to 10 with low scores indicating that the cancer cells are not very aggressive and are less likely to spread, and high scores indicate the cancer is aggressive and more likely to spread.

The severity or stage of prostate cancer is determined from a combination of factors, including the Gleason score, tumour size, whether there is lymph node involvement, whether there is spread to other organs and also the PSA level.

Treatment options for prostate cancer

Active surveillance
Prostatectomy
Radiotherapy
Androgen Deprivation Therapy (ADT)
Chemotherapy
Many new and upcoming treatments are constantly being developed

What is the role of the Endocrinologist?

Endocrinologists such as Dr Cheung specialize in treating men undergoing androgen deprivation therapy for prostate cancer to monitor for any potential long-term side effects and treat any side-effects early to maximise quality of life and maintain general health. Prognosis of prostate cancer varies between individuals, but in general survival rates are high. As most men survive their prostate cancer, it is critical that we minimise the chance of developing any new medical conditions and prevent long-term side effects from the treatment itself. It is recommended (but certainly not essential) that you have your first consultation with Dr Cheung before or shortly after starting ADT.

Dr Cheung works in close collaboration with other doctors to treat patients with prostate cancer, including urologists, radiation oncologists, oncologists and GPs.

About Androgen Deprivation Therapy

Androgen Deprivation Therapy (ADT), also known as hormone therapy, is an effective treatment for prostate cancer in men, which is generally used for higher risk prostate cancer. Testosterone, a normal male sex hormone has multiple functions in a man, which is not limited to only sexual function, but also regulating metabolism, body hair, body fat, mood and cognition and maintaining the strength of muscles and bones. However, as testosterone acts somewhat like a fuel for prostate cancer, ADT acts to reduce testosterone to extremely low undetectable levels, thereby ‘starving’ prostate cancer cells of any fuel. This is an effective treatment for prostate cancer cells throughout the entire body, not just in the prostate, so can have effect on cells that have spread elsewhere or metastasised. Lowering testosterone levels by ADT can be somewhat considered to be like what happens with menopause for women (as at menopause, estrogen levels are lowered) and symptoms can be similar to menopause.

How long is Androgen Deprivation Therapy for?

The duration of treatment with ADT is individualized but is often either 6 months, or long-term (18 months-3 years). Sometimes, ADT is given intermittently (for a few months, and then stopped and started). It is sometimes given in combination with radiotherapy. Your doctor will be able to advise the precise duration of treatment based on weighing up potential benefits and risks of treatment.

How is Androgen Deprivation Therapy given?

ADT comes in various forms but they are generally all injections. They may be given into a large muscle (buttock or arm), or into the fat around the abdomen. There are 3 monthly injections, and also 6 monthly injections which should be given by a doctor or a nurse. Any doctor can provide a prescription for ADT.

Side-effects of Androgen Deprivation Therapy

Side-effects can occur with ADT, but not every man experiences these side-effects. Some men are not affected at all, and some men are affected greatly. It is not possible to predict who will experience side-effects. Most men are able to (and are encouraged to) continue their usual activities such as working, hobbies or sports whilst having their treatment.

Possible side-effects of ADT include:

Hot flushes
Sexual dysfunction
Tiredness
Loss of energy and fatigue
Mood changes including depression
Decrease in the size of testes
Loss of body hair
Muscle weakness
Weight gain
High cholesterol
Diabetes
Thinning of the bones or osteoporosis

Dr Cheung will discuss potential side-effects in more detail and monitor regularly for the development of any side effects. Maintaining a healthy lifestyle with good diet and regular exercise is very beneficial for muscle and bone strength as well as for fatigue, mood and minimising weight gain.

How can I minimise side-effects of Androgen Deprivation Therapy?

There are many things that men can do to minimise side-effects and these include:

Regular exercise. This should be tailored to the individual, however a general recommendation is to perform 30 minutes of exercise at least three times a week.
No smoking
Reduced alcohol intake
Healthy diet to minimise weight gain.
Dietary calcium should include 2 to 3 serves a day, and if insufficient, calcium supplements may be recommended.
Vitamin D supplements may be required if levels are low.
Regular attendance for doctor’s visits to check blood pressure, cholesterol, blood glucose levels, weight and bone health.

For more information download Dr Cheung’s Androgen Deprivation Therapy Flyer