Androgen deprivation therapy (ADT), also called hormonal therapy, is a common treatment for metastatic prostate cancer. It works by depriving the cancer of testosterone, which fuels tumor growth.
There are two forms of ADT: surgical castration is performed through a procedure, and medical castration requires ongoing, usually lifelong, ADT treatment. Although medical castration is more common, it can also be costly, especially for those who are un or underinsured.
To answer your questions about the cost of ADT treatment, we spoke to Adam Weiner, MD, a urologic oncologist at Cedars-Sinai in Los Angeles. Here he details the financial side of treatment and offers tips for finding help paying for it.
Editor’s note: This interview has been edited for length and clarity.
Everyday health: how much does ADT cost?
However, individual costs vary depending on your health insurance, including which medications your plan covers and to what extent.
The most common form of ADT – and the most common covered form of ADT – is a depot injection, usually leuprolide, which is a hormone injection that essentially shuts off testosterone production in the testicles. Leuprolide (an LHRH [hormone] agonist) is usually covered by insurance, while the oral medication relugolix (Orgovyx) is not covered as often.
EH: Will I need to take other treatments besides ADT, and will that increase the cost?
AW: Maybe. If you have metastatic prostate cancer that is putting pressure on the spinal cord, for example, you may need more urgent treatment, such as radiation therapy. And, depending on your insurance coverage, additional treatments may increase out-of-pocket costs.
Some people may also need to take another medication called an LHRH antagonist, which works quickly to prevent the testosterone surge that can sometimes occur when you take LHRH agonists. Often these antagonists are not covered by insurance, so they end up being an out-of-pocket expense.
EH: Will I make monthly payments?
AW: It depends on the type of ADT you are taking.
ADT injections, for example, must be administered by a doctor every one, three, or six months. So you may have to pay for medications, as well as appointment fees, between 2 and 12 times a year. Most often, however, people receive injections every three months, which amounts to four payments per year. And exact monthly costs may vary depending on your insurance coverage.
Oral medications are taken daily and prescriptions may need to be filled every one to three months. In some cases, getting three months at a time may be cheaper than refilling monthly, depending on your prescription benefits.
EH: Could a pause in ADT help reduce treatment costs?
AW: Intermittent ADT—that is, taking a temporary break from hormone therapy before resuming it—is a viable treatment strategy for some people. However, this is not a decision that should be made for the sake of economy. Rather, it is used to alleviate some of the side effects of ADT, such as hot flashes or low libido.
EH: If ADT is too expensive, are there other treatments I can try instead?
EH: Are there any programs that can help me cover the cost of ADT?
AW: Yes. Nonprofit organizations and patient assistance programs are available to help cover the cost of some forms of ADT. Here are a few to check out:
These programs provide financial assistance to help cover expenses such as deductibles, co-pays, and out-of-pocket treatment costs.
Some pharmaceutical companies also offer patient assistance programs, which can help people with commercial insurance pay a small fee for their medications.
EH: Can a financial advisor or social worker help me find more economical resources?
AW: Certainly. You can often find this type of help at your cancer center. A financial counselor or social worker can help you find ways to pay for ADT as well as any other advanced prostate cancer treatments you may receive.
Takeaways
- The cost of androgen deprivation therapy (ADT) may depend on your individual health insurance plan and the form of ADT you are prescribed.
- You may also need other treatments for metastatic prostate cancer, such as radiation therapy, which can further increase the costs of care.
- You can find additional financial help from a social worker at the cancer center you attend or from various nonprofit organizations that help cover treatment costs.
