What should you know about neoadjuvant ADT for prostate cancer?

ADT stands for androgen deprivation therapy. It lowers the effect or availability of hormones such as testosterone that can stimulate some prostate cancer cells. When used before a prostatectomy or radiotherapy, it may shrink the prostate and cancer-containing tissue, allowing the treatment team to plan the next step more clearly. ADT is not the same as removing the prostate, and it does not replace the local treatment chosen for your cancer.

Treatment can involve injections, tablets, or both, depending on the medicines selected. Possible effects include hot flushes, reduced sexual desire, erection changes, tiredness, mood changes, and changes in bone or muscle health. Your team may review heart health, diabetes risk, medicines, and bone protection before or during treatment.

Ask how long ADT is planned to continue and whether it will finish before surgery or overlap with radiotherapy. Keep a record of injections and tablets, tell the team about heart or metabolic conditions, and report troublesome mood, sleep, sexual, or physical changes early. Regular movement, strength exercises suited to you, adequate protein, and not smoking can support muscle and bone health. Discuss bone-strengthening therapy if your clinician considers your bone health at risk.

Contact your oncology team promptly for chest pain, severe breathlessness, fainting, sudden weakness, or a new severe headache. Seek urgent assessment for inability to pass urine, rapidly worsening leg weakness, or loss of bladder or bowel control. Difficulty passing urine can have several causes, including prostate enlargement or treatment effects, so it needs assessment rather than a guess about cancer.

Which ADT medicine is planned, what side effects should I track, and how will you monitor my bones, heart health, mood, and blood tests? How does ADT fit with prostate removal surgery, radiotherapy, or brachytherapy? What symptoms should lead me to call the clinic the same day?