ADT Prostate Cancer Therapy Does More Harm Than Good

Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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ADT Prostate Cancer Therapy Does More Harm Than Good
A form of prostate cancer therapy called Androgen Deprivation Therapy (ADT) has been making significant headline news recently. It has a long history of use, but controversy over ADT has been heating up. Research reveals findings that severely question the efficacy of the decades old treatment. These findings have been quietly ignored, alarming and sadly detrimental to the user.

Dr. Oliver Sartor, medical director of the Tulane Cancer Center, lit up the media with a statement that ADT may do more harm than good. In fact, the concluding statement of the research article that Dr. Sartor commented on revealed very distressing information. The study found that “PADT (Primary Androgen Deprivation Therapy) was associated with a 12-fold higher prostate cancer death rate compared to those having a radical prostate surgery.” This was for men who had non-metastatic prostate cancer, the type of cancer that was least worrisome and least likely to grow and spread. The same study clearly stated that there is no evidence of any clinical benefit of PADT in the medical literature for men with localized prostate cancer. Further facts discussed in the study showed that PADT was associated with a threefold-higher risk of overall mortality. This means the localized prostate cancer was not the primary cause of death, but rather the risk from dying from other factors was enhanced three-fold when using PADT.

Prostate Cancer (PC) is the most common malignancy among men and accounts for 28% of all cancer cases in men. It is a significant issue in that there were nearly 240,000 new cases diagnosed and over 28,000 PC-induced deaths in 2012. Data from 2005 shows approximately 80% of all PC cases are diagnosed at the early, localized stage and survivors had a 5 year survival rate of nearly 100%. Prostate cancer occurs mainly in older men with the average age of diagnosis at 66. It is rare to see prostate cancer before the age of 40.

Androgen Deprivation Therapy (ADT) is used to suppress testosterone production and other androgen hormones in men who have prostate cancer. ADT therapy manipulates steroid chemistry and is used in place of radical surgery. In essence, it is chemical castration. ADT is used in the medical management of low risk clinically localized prostate cancer, metastatic prostate cancer, reoccurrence of prostate cancer after radical prostatectomy, lymph node metastasis, and non-symptomatic metastatic disease. It was started in 1941 to suppress testosterone levels in men who had advanced prostate cancer.

Much of the recent head turning controversy seen with ADT is in the context of low risk prostate cancer that has not spread elsewhere in the body. Localized prostate cancer is classified as low risk if the PSA level is less than 10 ng/ml, Gleason score is no higher than 6, and the T stage is between T1 and T2a. This type of PC is unlikely to grow or spread for many years and with the PC sufferer likely dying from other causes. The American Cancer Society provides conflicting statistical information. It states that “prostate cancer is the second leading cause of cancer death in American men.” Then it also states that “most men diagnosed with prostate cancer do not die from it.”

Men who have advanced or metastatic prostate cancer face similar risks with the use of ADT. It is certainly a controversial issue even in this context. One study admits that men who have advanced prostate cancer, even treated with ADT, will develop a disease that is refractory to all hormonal manipulations and will still continue to have ADT therapy recommended despite failure to provide benefit.

We need to start putting the pieces together and see the elephant in the room. ADT causes the group of steroid hormones called androgens to be substantially suppressed. Testosterone production naturally declines by 1-2% each year starting in the early thirties. This same age group of men that is at risk for prostate cancer simultaneously has a substantial decline in testosterone, DHEA, and other androgens known as andropause. Andropause is the men’s equivalent of the women’s menopause. A man experiencing natural andropause and then diagnosed with localized, low risk prostate cancer enters a precarious hormonal balance. Men are prescribed ADT because this is what their medical provider has to offer. The effect of natural andropause + ADT = double whammy on the metabolic physiology.

Andropause Symptoms and ADT Side Effects

Symptoms of natural andropause include:
• Decrease in lean body mass and increase in fat mass
• Decrease in energy and muscle strength
• Decrease libido and erectile dysfunction
• Increased osteoporosis
• Mood changes and mood swings (anger, depression, irritability)
• Hair loss
• Hot Flashes
• Changes in cognitive function

ADT medical therapies cause these same and additional symptoms but are thought of as side effects. Side effects increase the longer the therapy is used. Symptoms include:
• Thin or brittle bones (osteoporosis)
• Increase in body mass or obesity
• Increased lipid levels in the blood
• Reduced muscle mass
• Anemia
• Fatigue
• Increased risk of metabolic syndrome or diabetes
• Hot flashes
• Erectile dysfunction
• Decreased libido
• Breast enlargement
• Cognitive impairment
• Depression

Additional ADT Consequences

ADT therapy not only causes these symptoms but has other potentially very harmful consequences. A year long study published in the World Journal of Urology in 2013 showed for the first time that ADT therapy in prostate cancer caused a major increase in fibrinogen, which is a significant marker of inflammation. The same study showed the C-Reactive Protein did not elevate, but other factors changed. Total cholesterol, LDL, and blood glucose levels all increased with ADT treatment. Unfortunately, many medical professionals do not test for levels of fibrinogen and rely only on C-Reactive Protein. Fibrinogen is a protein found in the blood stream that is used to form clots. It protects you from dangerous bleeding when in an accident, injury, or other cases. Elevated lab levels of fibrinogen increases the risk of developing a blood clot and risk for heart attack and stroke. In fact, a meta-analysis study released just a few months ago reviewed results from nearly 130,000 ADT users. It demonstrated a marked increase of cardiovascular disease and deaths related to ADT and cardiovascular disease.

Studies relate ADT to metabolic syndrome and cardiovascular disease with its ability to negatively affect adiponectin, leptin, and insulin like growth factor. In fact, men who had advanced prostate cancer and were treated with ADT developed elevated levels of insulin-like growth factor BP-1 (IGFBP-1). Research showed that having elevated IGFBP-1 was associated with treatment resistance prostate cancer and early death from metastatic prostate cancer.

Men diagnosed with non-metastatic localized prostate cancer or any type of PC need to have extensive discussions with their medical provider and to get multiple opinions. A meta-analysis study in the British Medical Journal May 2014 compared what types of treatment showed most efficacious and safety showed no superiority in outcome of treatment amongst the different types versus “watchful waiting."

Tools and Support

Exercise and endurance training offers a chance for ADT treated prostate cancer patients to counteract the adverse effects of ADT therapy. Because ADT interferes with insulin sensitivity and leads to low muscle mass, obesity, and muscle weakness, exercise and endurance training helps improve these responses. Researchers found that men who performed aerobic activity or resistance exercise training for 24 weeks were able to significantly reverse the negative changes in leptin and other factors that were caused by the ADT.

It is absolutely imperative to keep inflammation levels in check with andropause and ADT therapy. Chronic low level inflammation or wear and tear that is not managed fuels the fire. Blood sugar and leptin levels must be addressed. Cancer thrives on sugar. This means that if your blood sugar is chronically elevated even just slightly, it will fuel the fire. Follow The Leptin Diet. Improve blood sugar metabolism. There are several nutritional compounds that support healthy prostate and androgen receptor sites. These include selenium, glutathione, zinc, tocotrienols, fish oil, cruciferous veggies, saw palmetto, curcumin, calcium, vitamin D and others.

The writing on the wall should be obvious. Treatment with ADT for localized low risk PC is troublesome at best. Combine that with the natural age related hormone declines, and men can be blindsided into miserable health or worse. My concern is that men will follow a similar pathway as menopause women into the perils of hormone alteration and manipulation only to find that the cure is worse than the disorder.

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