Androgen Deprivation Therapy: Appropriate Patients, Timing to Initiate ADT, and Complications

Androgen deprivation therapy (ADT) still remains the foundation of high-risk and metastatic prostate cancer treatment. Since the discovery of the androgen-dependent nature of prostate cancer, ADT has been used in various treatment settings. ADT is used as an adjuvant treatment with radical prostatectomy, in combination with radiation, or as a palliative option for metastatic disease. Based on the clinical context, the optimal timing of ADT varies. More recently the role of intermittent ADT has also been shown to improve quality of life while reducing cost of treatment. However, ADT is associated many significant complications that affects many organ systems. These range from cardiovascular and metabolic abnormalities to decreased bone density and cognitive and emotional disturbances. It is important to understand not only the role and appropriate timing of ADT use in the treatment of prostate cancer but also the need to counsel patients regarding potential complications and side effects of this treatment.