Androgen deprivation therapy (ADT) is an old standby for the treatment of men with metastatic or advanced prostate cancer. We have long known that testosterone plays an integral role in the progression of prostate cancer, thus we often use it as an initial treatment for men who become metastatic. ADT is used both for men with radiographically measurable metastatic disease as well as those with only a biochemical recurrence (PSA only increase after a failure of primary local treatment).

ADT is usually an effective treatment at this stage as it does lower PSA values; however it is also associated with significant side effects. In a recent survey of 153 men 90% reported having at least one side effect and 137 men (41%) reported concerns about the side effects.

Many of us, as well as our physicians, believe that these side effects are caused only by the prevention of testosterone production. In reality, the side effects are also related to the increase of relative estrogen levels related to testosterone levels. In the normal male testosterone is converted to estradiol which plays a significant physiological role in men. The reduction of testosterone and thus the reduction of estradiol contribute to multiple ADT side effects