Androgens
Any substance, such as testosterone or dihydrotestosterone, that promotes male characteristics (e.g., body hair growth).
Androgen deprivation therapy (ADT)
Also known as hormone (or hormonal) therapy, is a therapy designed to inhibit the body’s production of androgens, testosterone in particular. It also includes androgen receptor pathway inhibitors (ARPIs) that prevent androgen receptors on cells from binding to androgens that would stimulate their growth.
Androgen receptor pathway inhibitors (ARPIs)
A class of drugs that target the androgen receptor signaling pathway involved in prostate cancer progression. These inhibitors are of two types: those that block the production of androgens (i.e., abiraterone) and those that directly block the androgen receptors on cancer cells (e.g., enzalutamide, apalutamide and darolutamide). ARPIs have also been referred to as ARATs (androgen receptor axis-targeted agents), ARSIs (androgen receptor signaling inhibitors), and ARTAs (androgen receptor targeted agents).
Bone Mineral Density (BMD)
A measure of the amount of mineral in bone, which gives it its strength. Mild loss of BMD is called osteopenia and more serious loss is called osteoporosis. A person with osteoporosis is at increased risk of breaking a bone should he or she fall.
Bone Scan
A nuclear medicine imaging test used to detect cancer that has spread to the bones.
Cognitive function
An intellectual process by which one becomes aware of, perceives, or comprehends ideas. It involves all aspects of perception, thinking, reasoning, and remembering.
Diabetes
A group of endocrine diseases characterized by sustained high blood sugar levels. If left untreated, diabetes can lead to permanent injury to the cardiovascular system, the nervous system, the eyes, and kidneys.
Diethylstilbesterol (DES)
A synthetic (man-made) estrogen compound that was the first oral medication used for ADT, but was replaced by other drugs because it was associated with a high incidence of blood clot formation.
Doublet therapy (ADT2)
This is therapy where another drug, such as an ARPI, is added to standard ADT to intensify the therapy. See androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) above.
Dual-energy x-ray absorptiometry (DEXA or DXA)
A type of x-ray imaging used to measure bone mineral density.
E2-I
Our abbreviation for the Estradiol Initiative program.
Estradiol (E2)
The most potent naturally occurring estrogen found in both males and females. At a high dose it can reduce the signal from the brain to the testicles to produce testosterone. At a low dose it can reduce the incidence of hot flashes for men on ADT and help prevent osteoporosis.
Estrogens
Any of several steroid hormones that are secreted primarily by the ovaries and placenta in females. They promote the development of female secondary sex characteristics (e.g., breasts). In males, the primary estrogen is estradiol, and it is normally made from testosterone by the enzyme aromatase. See also Hormones.
Gynecomastia
A non-cancerous increase in the size of the breasts in a male often associated with discomfort or extra sensitivity in the breast.
Hormones
Hormones are compounds in the body that are produced by endocrine glands and have specific target tissues in the body (e.g., breast, prostate). They activate or suppress activity in their target tissue. Hormones can be internally secreted or obtained from pharmacological products taken as drugs.
Hormone Intensification
When an ARPI is taken together with standard androgen deprivation therapy. Adding an ARPI to standard ADT intensifies the ADT effectiveness.
Hormone therapy
A treatment that uses medications to alter hormone levels in the body, either by adding, blocking, or removing hormones.
Hot flashes
A sudden but brief sensation of intense heat typically experienced in the upper body and face, and often accompanied by sweating and flushing of the skin.
LHRH agonists (e.g., Lupron, Eligard, Zoladex) and LHRH antagonists (e.g., Firmagon)
Alternative names for the two classes of synthetic hormones called GnRH agonists and antagonists. These drugs stop the signal from the pituitary gland to the testicles to make testosterone. The drugs mentioned by name here are administered as long-acting depot injections. There is also one oral LHRH antagonist, Orgovyx. The LHRH agonists are the most common drugs used for ADT.
Libido
Sex drive or the desire for sex.
Mastalgia
Breast tenderness, sensitivity and pain often associated with gynecomastia.
Metabolic syndrome
A condition associated with obesity, including elements such as glucose intolerance, insulin resistance and elevated blood pressure. It is associated with an increased risk of cardiovascular disease and diabetes.
Night sweats
Episodes of hot flashes and sweating during sleep. Unlike normal perspiration, night sweats are intense and can disturb sleep.
Off-label
The practice of prescribing a drug for a different purpose than what the FDA approved.
Orgovyx
Also known by the generic name, relugolix, is a medication used to treat prostate cancer by supressing the signal from the brain for testes to produce testosterone. It is a LHRH antagonist, meaning it works by blocking the LHRH receptor in the pituitary gland.
Osteoporosis
A disorder in which the bones become increasingly porous, brittle, and subject to fracture, because of a loss of calcium and other mineral components. Osteoporotic fractures can lead to decreased height and skeletal deformities. Osteoporosis is common in older people, primarily postmenopausal women, but is also associated with androgen deprivation in men.
PATCH/STAMPEDE
A large clinical trial in the UK that compared the safety and effectiveness of the standard drugs used to treat systemic prostate cancer with transdermal estradiol (tE2). The trial found estradiol delivered through patches was equally good for cancer control to the standard drugs, but provided patients better quality of life.
PCa
Abbreviation for prostate cancer.
Positron emission tomography (PET scan)
A form of diagnostic imaging that uses radioactive substances (radiotracers) to visualize changes in metabolic processes or blood flow in the body. PET scans are often used together with a CT scans, as a PET-CT scan, to locate the spread of cancer in the body.
Prostatectomy
The surgical removal of part or all of the prostate gland. If there is partial removal (e.g., for benign disease), it is termed a ‘partial prostatectomy’. If the full gland is removed, it is ‘radical prostatectomy.
Prostate-specific antigen (PSA)
A protein, produced by prostate cells, elevated levels of which may indicate the presence of prostate cancer or other prostatic disease. See also PSA test.
PSA test
A blood test that measures the amount of PSA in the serum. See also Prostate-specific antigen.
PSMA agents
PSMA (Prostate specific membrane antigen) is a molecule on the surface of prostate cells. A radioligand can be bound to it to help locate the cells in a PET scan. If the radioligand releases high dose radiation, it can also be used to kill the cancer cells.
Quality of Life (QoL)
A multidimensional concept encompassing physical, emotional and social well-being that collectively contribute to the ability to engage in activities that are most meaningful to an individual
Radiation therapy
Use of high-energy, penetrating waves or particles, such as x-rays, gamma rays, proton beams or neutron beams, to destroy cancer cells or keep them from reproducing
Radioligand
A radioactive molecule that can be bound to cells to help either image them on scans or to kill them with toxic radiation depending on the type of radiation they emit.
Schellhammer Urological Research Foundation (SURF)
A non-profit research consortium in Virginia, USA, that sponsors the Estradiol Initiative. See: https://surffoundation.org/
Standard of care
The established and accepted medical treatments that are considered appropriate for a specific type and stage of cancer and endorsed by heath authorities.
Testosterone
The primary sex hormone in males, secreted by the testes, which stimulates the development of male sex organs, secondary sexual traits, and sperm. See also Androgen and Hormones
Thrombus
A blood clot that forms inside a blood vessel, which can impede blood flow or can be displaced and travel down the vessel. The process of forming the clot is called thrombosis. A thrombus that has moved is called an embolus.
Triplet therapy (ADT3)
This is therapy where another drug is added to double therapy (see above); this could be chemotherapy or other drugs. See Androgen deprivation therapy (ADT).
Transdermal
Transdermal means through the skin; a route of administration for medications as an alternative to taking them orally or through injections. Some medications (e.g., estrogens) are safer when administered transdermally.