SUMMARY:
Androgen Deprivation Therapy (ADT), a standard treatment for prostate cancer that has spread beyond the gland, halts the cancer by depriving prostate cancer of testosterone. It carries known side effects ranging from hot flashes to bone loss. A new study using F-18 FDG-PET/MRI imaging found that ADT is associated with progressive arterial inflammation in major arteries, possibly leading to heart disease, heart attacks, and strokes. Since ADT remains the clinical standard of care for advancing prostate cancer, regular cardiovascular risk assessment is recommended during treatment.
What is Androgen Deprivation Therapy?
Androgen Deprivation Therapy (ADT, also called hormone therapy) is used to treat prostate cancer that has begun to spread beyond the gland. As the name suggests, it deprives prostate cancer cells of the testosterone (male hormone or androgen) that fuels their growth. It is not a cure, but it extends survival by halting the progression of the disease.
How does ADT work?
Dr. Dan Sperling explains how ADT works:
ADT uses pharmaceutical drugs to block the systemic effects of androgens throughout the body, and of course, in PCa cells. There are three types of blockade that can be used alone or in combination:
- Androgen receptor antagonists inhibit androgen binding to androgen receptors; drugs include flutamide, bicalutamide, apalutamide, or enzalutamide
- LHRH agonists prevent the pituitary gland from producing the hormone needed for the testicles to produce androgens, thereby shutting off the flow; drugs include Lupron, Zoladex, etc.
- CYP17 inhibitor prevents PCa cells themselves from making small amounts of androgens; currently the drug abiraterone (Zytiga) is used for this.
Does ADT have side effects?
Yes, ADT affects many systems in a man’s body. Because testosterone and other androgens are responsible for the characteristics that make a man a man, when those characteristics are “switched off” the side effects are similar to castration (surgical removal of the testicles). Potential effects include:
- Hot flashes
- Breast enlargement/tenderness
- Loss of sexual desire
- Erectile dysfunction
- Fatigue
- Mood changes (depression, crying)
- Weight gain
- Higher cholesterol
- Less muscle mass
- Osteoporosis, which can lead to bone fractures
- Anemia
These side effects are not completely avoidable but there are medications to help ease their severity.
Is there an effect on cardiovascular health?
Yes, according to Kim, et al. (2023), “There have been increasing reports of cardiovascular complications of androgen deprivation therapy (ADT) leading to worse outcomes among patients with prostate cancer.”[i]
In fact, the latest study reports that special magnetic resonance imaging (MRI) has detected inflammation in major arteries. Published research by Xue, et al. (2026) states, “In patients with prostate cancer, ADT is associated with consistent and progressive arterial inflammation, most prominently in carotid, iliac, and abdominal aortic regions.”[ii]
Since the arteries carry oxygenated blood from the heart into circulation throughout the body, inflamed arteries do not function normally. The British Heart Foundation explains that arterial inflammation can lead to major cardiovascular problems by damaging the lining of the blood vessel and destabilizing fatty plaques. The result can be issues like atherosclerosis, coronary artery disease, heart attacks, and strokes.
How did the researchers detect arterial inflammation?
The researchers used F-18 FDG-PET/MRI (isotope contrast-enhanced MRI) to follow 43 prostate cancer patients for changes in arterial function over time. Each patient had two scans over an average of 184 days (three months).
The team found that inflammation in the major arteries, the iliac and carotid arteries, worsened significantly over time.
Is there anything that can be done about this?
The first thing that can be done is monitor all patients on ADT using cardiovascular risk assessment and management methods at regular intervals. This type of preventive care is essential.
Beyond that, the team noted that the underlying biology driving a link between ADT and arterial inflammation is not completely understood. However, they found that among the 43 participants, the inflammation of those who were using statin drugs or antiplatelet therapy appeared to have been less impacted. They theorize that these measures might help, but more research would be needed.
Finally, the researchers also found that among obese patients on ADT, the arterial inflammation was even worse. While they don’t suggest weight control, it would seem obvious that maintaining healthy weight is an investment in longevity in all circumstances, including ADT use.
Given all the possible side effects of ADT, are there alternatives for patients with advanced disease?
At this time, ADT is a clinical standard of care for patients whose cancer is advancing outside the gland. Such patients may still have a local treatment to eliminate the primary tumor, but the systemic cancer control afforded by ADT is necessary.
Also, there are other temporary applications of ADT, for example, reducing gland size before a local treatment such as surgery or radiation to increase the effectiveness of the treatment. When ADT is discontinued, hormone levels return to normal as the drugs gradually wash out of the system.
Although ADT can diminish a man’s masculinity and quality of life, most patients feel the trade-off is worth it to put the brakes on their cancer.
Frequently asked questions
Q: Can ADT cure prostate cancer?
A: Androgen deprivation therapy is not a cure for prostate cancer. Instead, by depriving cancer cells of testosterone, it halts cancer growth and progression. However, eventually smart cancer cells find ways to bypass low hormone levels, adapting to make their own fuel or reactivating growth switches without needing the body’s normal testosterone. When this happens, it is called “castration resistant prostate cancer.”
Q: Are there any options if the cancer becomes castration resistant?
A: Studies of a new approach called bipolar androgen therapy (BAT) offer a promising way to extend time. While the patient remains on ADT, a very high dose of testosterone is administered over a 28-day period. As described by Denmeade, et al. (2022), once the cancer cells have become ADT-resistant, they become “…vulnerable to sudden exposure to high amounts of testosterone. … Flooding the prostate cancer cell with testosterone creates a problem for the cell. … This high level “gums up the works” so to speak. It disrupts the ability of the prostate cancer cell to divide as part of the growth cycle. In response, the prostate cancer cell either stops growing or dies.”[iii]
Content reviewed by Dr. Dan Sperling, M.D., DABR — updated August 2026
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Kim J, Freeman K, Ayala A, Mullen M et al. Cardiovascular Impact of Androgen Deprivation Therapy: from Basic Biology to Clinical Practice. Curr Oncol Rep. 2023 Sep;25(9):965-977.
[ii] Xue S, Hu C, Li L, Einspieler H, Kiss A et al. Longitudinal [18F]FDG PET/MR Assessment of Arterial Inflammation in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy. Circ Cardiovasc Imaging. 2026 Jul 28:e019636.
[iii] Denmeade S, Antonarakis ES, Markowski MC. Bipolar androgen therapy (BAT): A patient’s guide. Prostate. 2022 May;82(7):753-762.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
