Androgen deprivation therapy
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Androgen deprivation therapy (ADT), also called androgen suppression therapy or is a form of treatment in prostate cancer, which basically aims to slow prostate cancer growth by blocking the effect of androgens e.g. testosterone.
Such therapy is mainly used for treating men with intermediate- and high-risk localized prostate cancer in combination with radiotherapy 1,2.
Androgen deprivation can be achieved by bilateral orchiectomy or medical treatment with luteinizing hormone-releasing hormone agonists or antagonists, antiandrogens and adrenal androgen inhibitors 1.
Androgen deprivation therapy will lead to a shrinkage of prostate volume on imaging 3-7.
Beyond the prostatic volume decrease it has the following effects on an MRI of the prostate 3-7:
- T2: loss of T2 signal 3,5
- increase of ADC values in prostate cancer
- decrease of ADC values of benign prostatic tissue
- DCE (Gd): reduced dynamic enhancement of prostate cancer 4,6
On PSMA PET-CT androgen deprivation therapy leads to reduced visibility of hormone-sensitive prostate cancer 8.
- 1. Perlmutter M & Lepor H. Androgen Deprivation Therapy in the Treatment of Advanced Prostate Cancer. Rev Urol. 2007;9 Suppl 1:S3-8. PMC1831539 - Pubmed
- 2. NICE guideline (published May 2019). Prostate cancer: diagnosis and management [NG131]
- 3. Chen M, Hricak H, Kalbhen C et al. Hormonal Ablation of Prostatic Cancer: Effects on Prostate Morphology, Tumor Detection, and Staging by Endorectal Coil MR Imaging. AJR Am J Roentgenol. 1996;166(5):1157-63. doi:10.2214/ajr.166.5.8615261 - Pubmed
- 4. Padhani A, MacVicar A, Gapinski C et al. Effects of Androgen Deprivation on Prostatic Morphology and Vascular Permeability Evaluated with MR Imaging. Radiology. 2001;218(2):365-74. doi:10.1148/radiology.218.2.r01ja04365 - Pubmed
- 5. Hötker A, Mazaheri Y, Zheng J et al. Prostate Cancer: Assessing the Effects of Androgen-Deprivation Therapy Using Quantitative Diffusion-Weighted and Dynamic Contrast-Enhanced MRI. Eur Radiol. 2015;25(9):2665-72. doi:10.1007/s00330-015-3688-1 - Pubmed
- 6. Barrett T, Gill A, Kataoka M et al. DCE and DW MRI in Monitoring Response to Androgen Deprivation Therapy in Patients with Prostate Cancer: A Feasibility Study. Magn Reson Med. 2011;67(3):778-85. doi:10.1002/mrm.23062 - Pubmed
- 7. Kim A, Kim C, Park S, Park B. Diffusion-Weighted Imaging to Evaluate for Changes From Androgen Deprivation Therapy in Prostate Cancer. AJR Am J Roentgenol. 2014;203(6):W645-50. doi:10.2214/ajr.13.12277
- 8. Afshar-Oromieh A, Debus N, Uhrig M et al. Impact of Long-Term Androgen Deprivation Therapy on PSMA Ligand PET/CT in Patients with Castration-Sensitive Prostate Cancer. Eur J Nucl Med Mol Imaging. 2018;45(12):2045-54. doi:10.1007/s00259-018-4079-z - Pubmed