Androgen Deprivation Therapy

Richard J. Wassersug, PhD, is a research scientist who earned his doctoral degree in evolutionary biology from the University of Chicago in Illinois. He then spent most of his career studying the biology of amphibians and teaching anatomy in the medical school at Dalhousie University in Halifax, Nova Scotia. At the age of 52 years, he was diagnosed with prostate cancer and has received multiple treatments for the disease. After beginning androgen deprivation therapy, he redirected his research to study the psychology of androgen deprivation in various populations. Wassersug now holds the title of Honorary Professor at the University of British Columbia, Vancouver, Canada.Lauren M. Walker, PhD, R Psych, is an Adjunct Associate Professor in the Department of Oncology's Division of Psychosocial Oncology and the Department of Psychology at the University of Calgary in Alberta. She is a registered clinical psychologist in the province of Alberta and operates a private clinical psychology practice for individuals with sexual concerns (see www.drlaurenwalker.com). She completed a clinical fellowship in 2015 specializing in oncology and sexuality, where she focused on developing programs to help cancer patients adapt to sexual changes after cancer treatment. She received her doctorate in clinical psychology in 2013 from the University of Calgary. There she completed her dissertation, which evaluated a patient education initiative for prostate cancer patients (and their partners) starting androgen deprivation therapy. Walker established the University of Calgary's Oncology Sexual Health Lab and maintains an active research program. She also maintains an Instagram account aimed to decrease stigma and to disseminate scientific and clinical knowledge about sexuality (www.instagram. com/drlaurenwalker).John W. Robinson, PhD, R Psych, was a clinical psychologist and member of the Genitourinary and Gynaecological Cancer Programs at the Tom Baker Cancer Centre in Calgary, Alberta, from 1986 until he retired in 2019. Robinson's career focused on providing clinical services and creating and evaluating new ways to ease the psychological burden of cancer on not just patients but also their loved ones. He continues to hold an adjunct associate professorship in the Departments of Oncology (Division of Psychosocial Oncology) and Psychology at the University of Calgary, where he continues to be involved in research.

Androgen deprivation therapy is the main treatment for locally advanced and metastatic prostate cancer. It is a very effective treatment, but it has major impact on many aspects of men's health. Thousands of articles have been dedicated to that subject. This book distills these down and provides a comprehensive understanding and path forward for the many challenges associated with androgen deprivation therapy."—David Crawford, M.D., Professor of Urology, University of California San Diego"As someone who has treated men with prostate cancer for over 25 years, I recognize the burden of care of the patients and their loved ones. This book provides excellent tips on how to deal with the disease. I have used prior versions for many years in my practice and wholly endorse this new version. It’s a must read!" —Neil Fleshner, MD, Chair of Urology, University of Toronto Ontario, and Love Chair in Prostate Cancer Prevention, Princess Margaret Cancer Centre, Toronto, Ontario

• Foreword, Hendrik Van PoppelForeword, Paul F. Schellhammer, MD, FACSPrefaceIntroductionBefore You BeginWill Reading This Book Make Me More or Less Anxious?I Have Never Read a Manual Before—Why Start Now?How to Read This BookWhat Are Your Values?Where to Go for Further InformationMoving Forward: Questions for DiscussionPART ONE: ANDROGEN DEPRIVATION THERAPYWhat Is Androgen Deprivation Therapy?How Does Androgen Deprivation Therapy Work?Abiraterone and Androgen AnnihilationAndrogen Receptor-Targeted Agents and Hormonal IntensificationA More In-Depth Look at Luteinizing Hormone-Releasing Hormone Agonists Versus AntagonistsYet Other Forms of Androgen Deprivation TherapyThe Original Androgen Deprivation TherapyThe Future of Androgen Deprivation TherapyWhat Medications Are You Taking for Androgen Deprivation Therapy?How Long Will I Be on Androgen Deprivation Therapy?What Is the Prostate-Specific Antigen Test?How Is the Prostate-Specific Antigen Test Used for Men Who Have Been Treated for Prostate Cancer?How Is the Prostate-Specific Antigen Test Used When You Are on Androgen Deprivation Therapy?How Good Is the Prostate-Specific Antigen Test?How Long Will Androgen Deprivation Therapy Control My Cancer?Moving Forward: Questions for DiscussionPART TWO: PHYSICAL SIDE EFFECTSHot FlashesMedicationsA Device That May Help With Hot FlashesCounselingActivity: Abdominal Breathing/Paced RespirationActivity: Hot Flash DiaryWeaker BonesWeight Gain and Muscle LossDiabetesMetabolic Syndrome and Cardiovascular RiskAnemia and FatigueBreast Growth and DiscomfortGenital ShrinkageLoss of Body HairOther Possible Side EffectsActivity: Pros/Cons TableActivity: Action PlanAction Plan Example: Practice Abdominal Breathing to Help With Hot FlashesActivity: Goal Setting and ConfidenceActivity: Side Effects Self-AssessmentPhysical Side Effects: EssentialsMoving Forward: Questions for DiscussionPART THREE: EXERCISEExercising SafelyCautionWarm-Up ExercisesAerobic ExercisesResistance TrainingKeeping Your Bones HealthyYoga and Tai ChiCool DownMaking the Decision to ExerciseHabit and ReasonActivity: Pros/Cons TableSetting Goals That Are SMART for YouExample SMART GoalsWhat Are Your SMART Goals?Activity: Matching Meaning and Change Using Self-StatementsMeaning Self-StatementsPreparing to Successfully Begin ExercisingYour Action PlanWhen Do You Plan to Do ItWhere Do You Plan to Do ItWho Might You Do It WithActivity: Action PlanAction Plan Example: Start Walking RoutinelyActivity: Goal Setting and ConfidenceMaintaining Your MotivationManaging Lapses and RelapsesReward YourselfSupportActivity: Identifying and Overcoming Barriers to Starting and Maintaining an Exercise ProgramExercise: EssentialsMoving Forward: Questions for DiscussionPART FOUR: HEALTHY EATINGReading Food LabelsFatsProteinCarbohydratesDetermining Your Current Body Mass IndexEstimating Your Nutritional NeedsOmega-3 Fatty AcidsOmega-6 Fatty AcidsSoyVitamin DHow Do I Get Enough Vitamin D?CalciumCalcium in Your DietPhytonutrientsPolyphenolsPunicalagin and Ellagic AcidLycopeneActivity: Pros/Cons TableActivity: Action PlanAction Plan Example: Eat Healthier SnacksActivity: Goal Setting and ConfidenceHealthy Eating: EssentialsMoving Forward: Questions for DiscussionPART FIVE: EFFECTS ON PSYCHOLOGICAL WELL-BEINGEmotional DistressEmotional ExpressionActivity: Self-Assessment—Screening for Emotional DistressDepressionAnxietyActivity: Progressive Muscle RelaxationActivity: Mindfulness MeditationInstructionsFatigueGriefCognitionActivity: Pros/Cons TableActivity: Action PlanAction Plan Example: Work on Stress ManagementAction PlanActivity: Goal Setting and ConfidenceEffects on Psychological Well-Being: EssentialsMoving Forward: Questions for DiscussionEmotional ChangesCognitive ChangesPART SIX: EFFECTS ON INTIMATE RELATIONSHIPS AND SEXUALITYAndrogen Deprivation Therapy Lowers Sexual DesireHow the Loss of Sexual Desire Affects CouplesStaying Close in Nonsexual WaysMaking Time for IntimacyDatingBeing Open and HonestMaintaining a Sexual RelationshipSuggestions for Enjoying Sensual Pleasure With Low Sexual DesireBe Flexible About Who Initiates IntimacyRedefine Your Sexual ActivitiesTake the Focus Off OrgasmBe Aware of Decreased Responsiveness to Sexual TouchEnhancing Awareness of Sensation With MindfulnessStimulate Your Sexual AppetiteOrgasms Without EjaculationSex: Beyond IntercourseSuggestions for Pleasing Your Female PartnerSuggestions for Pleasing Your Male PartnerUsing Sexual Aids and Sex ToysSexual Devices to Permit Insertive Sex Without ErectionsTreatments for Erectile DysfunctionGeneral Comments on Using Erectile Assistive AidsOral MedicationsInjectionsIntraurethral SuppositoriesVacuum PumpInflatable Penile ProsthesisSolo MasturbationThe Use of Lubricants for MenDeveloping New Sexual PracticesActivity: Beliefs AwarenessActivity: Pros/Cons TableActivity: Action PlanAction Plan Example: Increasing Physical Affection With My PartnerAction Plan Example: Getting Out MoreActivity: Goal Setting and ConfidenceEffects on Intimate Relationships and Sexuality: EssentialsMoving Forward: Questions for DiscussionQuestions for Single MenQuestions for CouplesPART SEVEN: IMPACT ON COMMITTED RELATIONSHIPSPotential Changes in the RelationshipChanges in the Way You Interact With Each OtherDifferences in Coping StyleIncreased Self-DoubtOne Thing to AvoidActivity: Pros/Cons TableActivity: Action PlanAction Plan Example: Communicate More Effectively With My PartnerActivity: Goal Setting and ConfidenceImpact on Committed Relationships: EssentialsMoving Forward: Questions for DiscussionPART EIGHT: UNIQUE CONSIDERATIONS FOR GAY RELATIONSHIPSAndrogen Deprivation Therapy May Impact Committed Relationships for Gay MenActivity: Pros/Cons TableActivity: Action PlanAction Plan Example: Communicate More Effectively With My PartnerActivity: Goal Setting and ConfidenceUnique Considerations for Gay Relationships: EssentialsMoving Forward: Questions for DiscussionPART NINE: CONCLUSION: STAYING HEALTHYAppendixDrug ChartProstate-Specific Antigen (PSA) ChartHot Flash DiaryPros/Cons TableAction PlanGoal Setting and ConfidenceSide Effects Self-AssessmentScreening for Emotional Distress Mood Questionnaire, Symptoms of Distress QuestionnaireBeliefs Awareness ExerciseGlossaryResourcesBibliographyAcknowledgementsIndexContributorsAbout the Authors