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.

Foreword, Hendrik Van Poppel

Foreword, Paul F. Schellhammer, MD, FACS

Preface

Introduction

Before You Begin

Will Reading This Book Make Me More or Less Anxious?

I Have Never Read a Manual Before—Why Start Now?

How to Read This Book

What Are Your Values?

Where to Go for Further Information

Moving Forward: Questions for Discussion

PART ONE: ANDROGEN DEPRIVATION THERAPY

What Is Androgen Deprivation Therapy?

How Does Androgen Deprivation Therapy Work?

Abiraterone and Androgen Annihilation

Androgen Receptor-Targeted Agents and Hormonal Intensification

A More In-Depth Look at Luteinizing Hormone-Releasing Hormone Agonists Versus Antagonists

Yet Other Forms of Androgen Deprivation Therapy

The Original Androgen Deprivation Therapy

The Future of Androgen Deprivation Therapy

What 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 Discussion

PART TWO: PHYSICAL SIDE EFFECTS

Hot Flashes

Medications

A Device That May Help With Hot Flashes

Counseling

Activity: Abdominal Breathing/Paced Respiration

Activity: Hot Flash Diary

Weaker Bones

Weight Gain and Muscle Loss

Diabetes

Metabolic Syndrome and Cardiovascular Risk

Anemia and Fatigue

Breast Growth and Discomfort

Genital Shrinkage

Loss of Body Hair

Other Possible Side Effects

Activity: Pros/Cons Table

Activity: Action Plan

Action Plan Example: Practice Abdominal Breathing to Help With Hot Flashes

Activity: Goal Setting and Confidence

Activity: Side Effects Self-Assessment

Physical Side Effects: Essentials

Moving Forward: Questions for Discussion

PART THREE: EXERCISE

Exercising Safely

Caution

Warm-Up Exercises

Aerobic Exercises

Resistance Training

Keeping Your Bones Healthy

Yoga and Tai Chi

Cool Down

Making the Decision to Exercise

Habit and Reason

Activity: Pros/Cons Table

Setting Goals That Are SMART for You

Example SMART Goals

What Are Your SMART Goals?

Activity: Matching Meaning and Change Using Self-Statements

Meaning Self-Statements

Preparing to Successfully Begin Exercising

Your Action Plan

When Do You Plan to Do It

Where Do You Plan to Do It

Who Might You Do It With

Activity: Action Plan

Action Plan Example: Start Walking Routinely

Activity: Goal Setting and Confidence

Maintaining Your Motivation

Managing Lapses and Relapses

Reward Yourself

Support

Activity: Identifying and Overcoming Barriers to Starting and Maintaining an Exercise Program

Exercise: Essentials

Moving Forward: Questions for Discussion

PART FOUR: HEALTHY EATING

Reading Food Labels

Fats

Protein

Carbohydrates

Determining Your Current Body Mass Index

Estimating Your Nutritional Needs

Omega-3 Fatty Acids

Omega-6 Fatty Acids

Soy

Vitamin D

How Do I Get Enough Vitamin D?

Calcium

Calcium in Your Diet

Phytonutrients

Polyphenols

Punicalagin and Ellagic Acid

Lycopene

Activity: Pros/Cons Table

Activity: Action Plan

Action Plan Example: Eat Healthier Snacks

Activity: Goal Setting and Confidence

Healthy Eating: Essentials

Moving Forward: Questions for Discussion

PART FIVE: EFFECTS ON PSYCHOLOGICAL WELL-BEING

Emotional Distress

Emotional Expression

Activity: Self-Assessment—Screening for Emotional Distress

Depression

Anxiety

Activity: Progressive Muscle Relaxation

Activity: Mindfulness Meditation

Instructions

Fatigue

Grief

Cognition

Activity: Pros/Cons Table

Activity: Action Plan

Action Plan Example: Work on Stress Management

Action Plan

Activity: Goal Setting and Confidence

Effects on Psychological Well-Being: Essentials

Moving Forward: Questions for Discussion

Emotional Changes

Cognitive Changes

PART SIX: EFFECTS ON INTIMATE RELATIONSHIPS AND SEXUALITY

Androgen Deprivation Therapy Lowers Sexual Desire

How the Loss of Sexual Desire Affects Couples

Staying Close in Nonsexual Ways

Making Time for Intimacy

Dating

Being Open and Honest

Maintaining a Sexual Relationship

Suggestions for Enjoying Sensual Pleasure With Low Sexual Desire

Be Flexible About Who Initiates Intimacy

Redefine Your Sexual Activities

Take the Focus Off Orgasm

Be Aware of Decreased Responsiveness to Sexual Touch

Enhancing Awareness of Sensation With Mindfulness

Stimulate Your Sexual Appetite

Orgasms Without Ejaculation

Sex: Beyond Intercourse

Suggestions for Pleasing Your Female Partner

Suggestions for Pleasing Your Male Partner

Using Sexual Aids and Sex Toys

Sexual Devices to Permit Insertive Sex Without Erections

Treatments for Erectile Dysfunction

General Comments on Using Erectile Assistive Aids

Oral Medications

Injections

Intraurethral Suppositories

Vacuum Pump

Inflatable Penile Prosthesis

Solo Masturbation

The Use of Lubricants for Men

Developing New Sexual Practices

Activity: Beliefs Awareness

Activity: Pros/Cons Table

Activity: Action Plan

Action Plan Example: Increasing Physical Affection With My Partner

Action Plan Example: Getting Out More

Activity: Goal Setting and Confidence

Effects on Intimate Relationships and Sexuality: Essentials

Moving Forward: Questions for Discussion

Questions for Single Men

Questions for Couples

PART SEVEN: IMPACT ON COMMITTED RELATIONSHIPS

Potential Changes in the Relationship

Changes in the Way You Interact With Each Other

Differences in Coping Style

Increased Self-Doubt

One Thing to Avoid

Activity: Pros/Cons Table

Activity: Action Plan

Action Plan Example: Communicate More Effectively With My Partner

Activity: Goal Setting and Confidence

Impact on Committed Relationships: Essentials

Moving Forward: Questions for Discussion

PART EIGHT: UNIQUE CONSIDERATIONS FOR GAY RELATIONSHIPS

Androgen Deprivation Therapy May Impact Committed Relationships for Gay Men

Activity: Pros/Cons Table

Activity: Action Plan

Action Plan Example: Communicate More Effectively With My Partner

Activity: Goal Setting and Confidence

Unique Considerations for Gay Relationships: Essentials

Moving Forward: Questions for Discussion

PART NINE: CONCLUSION: STAYING HEALTHY

Appendix



Drug Chart
Prostate-Specific Antigen (PSA) Chart
Hot Flash Diary
Pros/Cons Table
Action Plan
Goal Setting and Confidence
Side Effects Self-Assessment
Screening for Emotional Distress Mood Questionnaire, Symptoms of Distress Questionnaire



Beliefs Awareness Exercise

Glossary

Resources

Bibliography

Acknowledgements

Index

Contributors

About the Authors