ADT Side Effects & Different ADT Drugs

My radiologist at Dana Farber felt that the best way to alleviate side effects of hormone therapy is to be physically fit heading in and working hard during to maintain. Muscle loss is a real factor as testosterone disappears, keeping up resistance training will avoid the worse.
Eric

Dave's point is of interest with respect to side effects.

Orgovyx is taken once daily as a pill.

Lupron is injected once every month, 3 months or 6 months. This has to be done 'just so' and patients have reported side effects just from the injection.

In conclusion, the statement of the oncologist that these drugs all have the same effects is grossing over important issues. In other words, the side effects reported by patients vary considerably (as Clevelandguy already pointed out).

@Angstromm Although I'm not on ADT, I've done plenty of research in anticipation of being put on it one day. Like your bro, I am also experiencing a recurrence, but it's too early to do anything about it yet. I remain on active surveillance with quarterly blood tests.

There might not be much difference in side effects experienced by the same person between the different medications within a family of ADT drugs, for example Lupron vs. Zoladex in the case of LHRH agonists, but there can be a huge difference in side effects between the different families of ADT drugs. By that, I mean that if treatment was in the form of an anti-androgen such as Casodex taken as a monotherapy instead of an agonist like Lupron for example, the patient would experience far fewer sexual side effects and hot flashes and also maintain bone density, but might feel nauseous and might need to accept having breasts. Another family of hormone treatment, via good old-fashioned estrogen (Estradiol) will also minimize or eliminate the nasty side effects of the agonists and actually improve cognitive function compared to 'normal' men including the ability to multi-task! But it's feminizing effects may not be tolerable for some.

I firmly believe that every patient should be able to make an informed decision to take whatever drug suits their tolerance for certain side effects. For example, I dread hot flashes and cognitive issues, and if I had a choice I would select a drug that minimized those side effects, but unfortunately not every country permits the use of every different option.

You are correct. Antiandrogens can lead to adaptation of PCa's antiandrogens receptors.

The old bicalutamide (casodex) was made of a similar biostructure of the real androgen to assure that it would be absorbed/get stuck at the cell's receptors, but after extended periods of use, the AAWR (antiandrogen withdrawal response) occurred, showing that at some time, the bandit start feeding on the bicalutamide itself. The PSA would decrease significantly once stopping the antiandrogen.

In regards to ADT castration resistant occurrences, it starts when the bandit becomes independent of the testosterone for survival. It starts feeding on other androgens (for instance dihydrotestosterone) or even producing the means of survival by itself. Our body protection system doesn't recognize cancer as a bad thing. It will defende the cancerous cell from anything we throw at it. Darwin principle. (If interested you can read one of my old post on the matter)

The newer breed of antiandrogens called "androgen receptor signaling inhibitor" works differently and has shown more affinity sticking the mouth of the cancer, making it difficult of surviving. In other words, it provides some relieve to patients experiencing castration resistant PCa.

I am on apalutamide together with ADT (Eligard) due to a bone metastasis. My PSA is in remission levels. Hopefully it will maintain that status for one year when I plant to start my vacations off-drugs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468615/

I've been on Lupron plus Zytiga/Prednisone for a bit over a year, with another to go (plus started with RPS and then RT to regional lymph nodes). I had all the side effects mentioned, including having osteoporosis (so am also on Zometa). I say "had" because I just recently started the lowest dose Estradiol patch (0.025mg) and after about 2 weeks, the hot flashes vanished. I also am less fatigued. It should also help with bone loss, but if I see that on my next DEXA, I won't know whether it was that, the Zometa, or a combination. Search for the PATCH study, and papers by Russell and Grossmann.

In my humble opinion, the meds aren't the major cause of side effects.

The meds stop testosterone production and the lack of testosterone is what causes the major side effects.

It has been a year (next month) since my last Lupron injection. My testosterone has NOT recovered and I continue to have annoying side effects. At my age (77) the docs are saying it may take a LONG time for the testosterone to recover or I may need testosterone replacement therapy to get back to normal.

I also blamed the meds but, sadly, I feel they all have similar major side effects - caused by the lack of testosterone.

Does testosterone replacement therapy then have the opposite effect on your cancer