การรักษาด้วยการลดระดับแอนโดรเจนสำหรับมะเร็งต่อมลูกหมาก: กลไกการทำงานและค่าใช้จ่าย

อัปเดตล่าสุด: สิงหาคม 25, 2026

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Prostate cancer depends on testosterone to grow. Take the testosterone away and the cancer shrinks, often dramatically and often for years. That is androgen deprivation therapy, and it is one of the most effective treatments in urology.

It also asks a great deal of the man taking it. An earlier version of this article described how ADT works and how it is monitored without mentioning a single side effect. That was a serious omission on a page men read before starting treatment, and most of what follows is the correction.

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What it does, precisely

Prostate cancer cells are dependent on androgens to grow. Reducing testosterone to very low levels removes the fuel, and the cancer regresses.

It is worth being precise here, because the earlier wording — that testosterone drives prostate cancer aggressiveness — is easily misread. A man with a higher natural testosterone level is not thereby at greater risk of prostate cancer, and prostate tissue is already saturated at ordinary levels. What is true is the reverse direction: once a cancer exists, removing androgen starves it. That distinction matters to anyone reading this site’s pages on testosterone therapy as well.

When it is used

The earlier version said ADT is reserved for advanced disease. That is where it is most familiar, but it is not the whole picture, and the narrower statement has been corrected.

• Metastatic disease — the mainstay, usually now combined with additional agents rather than given alone.
• Alongside radiotherapy in intermediate- and high-risk disease that is still confined to the prostate, where adding ADT for a defined period improves the outcome of the radiotherapy.
• When the PSA rises after surgery or radiotherapy, depending on how fast it is rising.
• Where the cancer is localised and curable, ADT is not the treatment — surgery or radiotherapy is. See radical prostatectomy and how staging decides the route.

How testosterone is lowered

• Surgical removal of both testes — immediate, permanent, requires nothing further and costs nothing ongoing. It remains a perfectly reasonable option, chosen less often because it is irreversible and because many men find the idea difficult.
• LHRH agonists such as leuprolide or goserelin, given as injections at intervals from monthly to yearly. These work by overstimulating the pituitary until it shuts down — which produces an important quirk, described below.
• GnRH antagonists, given by injection or, in one case, by mouth. These block the signal directly instead of overstimulating it. They lower testosterone faster, cause no initial surge, and are worth discussing where cardiovascular disease is a concern. The earlier version of this article did not mention this class at all.

The first two weeks on an agonist: tumour flare

This was absent from the earlier version and is the one acute hazard of starting treatment.

Because LHRH agonists work by overstimulating the pituitary before exhausting it, testosterone rises sharply for the first week or two before it falls. In a man with extensive disease that brief surge can make the cancer temporarily more active — causing worsening bone pain, difficulty passing urine, or, most seriously, pressure on the spinal cord.

This is why an anti-androgen tablet is usually started shortly before the first injection and continued for a few weeks to cover the surge, and why an antagonist may be chosen instead in men most at risk. If you were not offered cover, ask why — and see the emergency symptoms below.

What ADT costs you — the section that was missing

These are common, not rare. Knowing about them beforehand makes them considerably easier to live with, and several can be actively managed rather than simply endured.

• Hot flushes — the commonest complaint, and treatable.
• Loss of sexual desire and erectile dysfunction, in most men. This is not a side note; it is often the hardest part, and it is worth discussing openly before starting rather than discovering afterwards.
• Fatigue, loss of muscle and strength, and weight gain, particularly around the abdomen. Resistance exercise genuinely counteracts this and is among the few things with good evidence behind it.
• Bone thinning, and fractures. Bone loss on ADT is rapid, and a fracture in this setting is a serious event. Bone density is assessed, and calcium, vitamin D, weight-bearing exercise and — for some men — bone-protecting medication are part of proper care rather than optional extras.
• Metabolic and cardiovascular effects — rising cholesterol, insulin resistance and new or worsening diabetes. Blood pressure, glucose and lipids belong in the monitoring, and a man with existing heart disease should have that weighed when the type of ADT is chosen.
• Mood change, low mood, and difficulty with memory and concentration. Men frequently do not connect these to the treatment and so never mention them.
• Breast tenderness or enlargement, and loss of body hair.

None of this is an argument against ADT where it is indicated. It is an argument for going into it with your eyes open, and for the follow-up to look at more than the PSA.

Monitoring

• PSA, at intervals, watching the trend rather than any single value.
• Testosterone, to confirm suppression has actually been achieved — a step that is skipped more often than it should be. The conventional target is below 50 ng/dL, with some evidence favouring a lower threshold still.
• Bone density, plus calcium and vitamin D.
• Blood pressure, glucose and lipids.

If the PSA rises while testosterone is confirmed to be at castrate level, the disease has become castration-resistant — which is not the end of treatment but the point at which further agents are added. There are considerably more of those available now than there were a few years ago.

Symptoms that are an emergency

ในกรณีฉุกเฉินในประเทศไทย โทร 1669.

• New weakness or numbness in the legs, difficulty walking, or loss of control of the bladder or bowel. This may be pressure on the spinal cord and is the most time-critical emergency in prostate cancer — treatment within hours preserves function that is otherwise lost permanently. Do not wait until morning.
• Severe or rapidly worsening bone pain, especially in the first weeks of an agonist.
• Inability to pass urine with a painful full bladder.
• Chest pain, sudden breathlessness, or pain and swelling in one calf.
• A fall with pain afterwards, in a man who has been on ADT for some time — bone thinning makes fractures easier.

Frequently Asked Questions About ADT

What are the side effects of androgen deprivation therapy?

Common and expected rather than rare: hot flushes, loss of desire and erectile dysfunction, fatigue, muscle loss and weight gain, bone thinning with fracture risk, rising cholesterol and blood sugar, low mood, difficulty concentrating, and breast tenderness. An earlier version of this article listed none of them. Several can be actively managed, which is why they are worth raising rather than tolerating.

What is tumour flare, and does it affect me?

LHRH agonists cause testosterone to rise for the first week or two before it falls, which can briefly worsen the cancer’s activity — bone pain, urinary obstruction, or pressure on the spinal cord in men with extensive disease. An anti-androgen tablet is usually given around the first injection to cover it, or a GnRH antagonist chosen instead, since antagonists cause no surge.

Is surgical removal of the testes still an option?

Yes, and it remains reasonable. It is immediate and permanent, needs no further injections and no ongoing cost, and its side effects are those of low testosterone rather than of the operation. It is chosen less often because it cannot be undone and because many men find the idea difficult, which is a legitimate reason.

Does high testosterone cause prostate cancer?

No. Existing prostate cancer depends on androgen to grow, which is what makes ADT work, but a higher natural testosterone level does not put a man at greater risk of developing the disease. These are different questions and are often confused.

Will I be on ADT for life?

It depends on why it was started. Given alongside radiotherapy for localised disease it usually runs for a defined period and then stops, and testosterone recovers over months, sometimes incompletely. In metastatic disease it generally continues. In some situations it is given intermittently, with breaks, to reduce the burden of side effects.

My PSA is rising while I am on ADT. What does that mean?

First, testosterone is checked to confirm suppression is genuinely being achieved. If it is, the disease has become castration-resistant — which is a point at which further treatments are added rather than the end of treatment.

การนัดหมายเพื่อปรึกษา

นพ. สรวีร์ วีระโสภณ รับผู้ป่วยที่ โรงพยาบาลกรุงเทพ สำนักงานใหญ่ และที่โรงพยาบาล สมิติเวช ศรีราชา ในจังหวัดชลบุรี เมื่อวันที่ 088-022-1445. Bring every previous PSA result with its date, the biopsy and staging reports, and a list of your other medicines and conditions — heart disease, diabetes and bone problems all bear on which form of ADT suits you.

โรงพยาบาลกรุงเทพฯ มีบริการแพทย์ทางไกลสำหรับผู้ป่วยที่ไม่สามารถมาพบแพทย์ด้วยตนเอง รวมถึงผู้ป่วยต่างชาติ กรุณาแจ้งล่วงหน้าทางอีเมลไปยังแผนกศัลยกรรมทางเดินปัสสาวะที่ bhquro@bdms.co.th. Samitivej Sriracha ให้บริการเฉพาะการพบแพทย์ด้วยตนเองเท่านั้น สอบถามเรื่องค่าใช้จ่ายได้ที่โรงพยาบาลโดยตรง ไม่ใช่ผ่านทางเว็บไซต์นี้.

ข้อจำกัดความรับผิดชอบ เนื้อหานี้ถูกเขียนและตรวจสอบโดย นพ. สรวีร์ วีระโสภณ ซึ่งเป็นแพทย์ผู้เชี่ยวชาญที่ได้รับการรับรองจากคณะกรรมการที่ โรงพยาบาลกรุงเทพ สำนักงานใหญ่ และมีวัตถุประสงค์เพื่อการศึกษาเท่านั้น เนื้อหานี้ไม่ใช่คำแนะนำทางการแพทย์ การวินิจฉัย หรือใบสั่งยาสำหรับบุคคลใดทั้งสิ้น และไม่มีการให้คำแนะนำ การวินิจฉัย หรือใบสั่งยาผ่านช่องทางส่งข้อความส่วนตัวหรือสื่อสังคมออนไลน์ นพ. สรวีร์ ไม่มีบัญชีสื่อสังคมออนไลน์สาธารณะใดทั้งสิ้น; บัญชีใดที่เสนอการปรึกษาส่วนตัวในชื่อของเขาเป็นการหลอกลวง ในกรณีฉุกเฉินในประเทศไทย ให้โทร 1669.