Does ADT work only on bone mets or organ mets also ?

[Tinkudi]

Just trying to learn.

Often I read that when someone is discovered with an organ Met like liver etc , they start on chemotherapy too.

Do ADT and ARPI also work on organ mets or only bone mets ?

Good day to all. Wednesday morning here in India !

[JohnInTheMiddle]

To answer your question as to whether ADT and ARPI work on both organ mets and bone mets, my understanding is this:

1. ADT, which covers both GnRH agonist and antagonist drugs, results in the suppression of testosterone manufacturing signals, especially to the testes. This has a system-wide impact, and this effects bones, lymph nodes, organs etc. (I'm not aware of any side effects directly affecting organs.) (Sometimes you can see GnRH referred to instead as LHRH.)

2. ARPI, being an "androgen pathway inhibitor", is complementary to ADT and stops testosterone synthesis triggered by any signaling hormones that happen to still be produced from the body. In the case of Abiraterone, this means shutting down the CYP17 enzyme which converts the precursor into testosterone. So again, testosterone manufacture is suppressed.

The two together become doublet therapy. The combo of ADT + ARPI are pretty good at delivering zero testosterone. Zero testosterone means that prostate cancer cells, wherever they are found, on bones or in organs etc., are starved for signaling permission to live. That is to say until these hungry and enthusiastic bast**ds figure out a different way of thriving without testosterone. Which we call resistance.

The "lutamides" are androgen receptor antagonists and work in a different way. They work directly on prostate cancer cells themselves. So if these nasty cells are found on organs, then that's a different situation which I'm not commenting on.

So the short answer to your question is that ADT and ARPI are complimentarily effective in suppressing testosterone. And that in turn means that the effects of ADT and ARPI apply to testosterone hormone-sensitive prostate cancer cells wherever they are found: bones, lymph nodes and organs etc.

[Tinkudi in reply to JohnInTheMiddle]

Thanks John 😊

[Tall_Allen]

All kinds of hormone therapy works on all cancer cells that are hormone-sensitive.