Adverse effects of androgen deprivation therapy in men with prostate cancer: a focus on metabolic and cardiovascular complications

Abstract

Prostate cancer (PCa) is the most common malignancy in men. Prostate being an androgen responsive tissue, androgen deprivation therapy (ADT) is used in the management of locally advanced (improves survival) and metastatic (improves pain and quality of life) PCa. Over the past two decades, the use of ADT has significantly increased as it is also being used in patients with localized disease and those experiencing biochemical recurrences, though without any evidence of survival advantage. Hypogonadism resulting from ADT is associated with decreased muscle mass and strength, increased fat mass, sexual dysfunction, vasomotor symptoms, decreased quality of life, anemia and bone loss. Insulin resistance, diabetes and cardiovascular disease have recently been added to the list of these complications. As the majority of men with PCa die of conditions other than their primary malignancy, recognition and management of these adverse effects is paramount. Here we review data evaluating metabolic and cardiovascular complications of ADT.

Estradiol for the mitigation of adverse effects of androgen deprivation therapy

“…Side effects of non-estrogen modes of ADT have been reviewed (Sharifi et al 2005, Grossmann & Zajac 2011, Collins & Basaria 2012, Cheung et al 2014) and will only be briefly outlined. There is a justified focus on such side effects, particularly because prolonged survival is expected in most men in whom this therapy is used.…”

Exercise medicine for prostate cancer

“…The other arrays of ADT toxicities encompass metabolic syndrome, type II diabetes and the increased risk of cardiovascular disease [3]. For example, it has been reported [15] that ADT is associated with an increased risk of diabetes (44 %), coronary heart disease (16 %), myocardial infarction (11 %) and sudden death (16 %), causing patients and clinicians to question the efficacy of ADT and possibly declining treatment.…”

“…For example, it has been reported [15] that ADT is associated with an increased risk of diabetes (44 %), coronary heart disease (16 %), myocardial infarction (11 %) and sudden death (16 %), causing patients and clinicians to question the efficacy of ADT and possibly declining treatment. This is not without justification, as the majority of men with prostate cancer will die of diseases other than their primary malignancy [3]. These treatment toxicities are of considerable concern and lead our team to embark on a series of studies to evaluate the efficacy of physical exercise to prevent or reverse such side effects.…”

“…ADT is being increasingly used in the management of prostate cancer, and while highly effective for slowing prostate cancer growth, it does result in a range of toxicities which impact negatively on the man and to varying degrees [3].…”

Does the use of Testosterone Enanthate as a Form of Doping in Sports Cause Early Closure of Epiphyseal in Bones?

“…Immune system (Khan et al), endocrine system, urogenital system (Collins & Basaria, 2012) not only cause the problems like that; but also reveal serious side effects on other systems in the body (Bispo et al, 2009) and prompt serious health problems (Di Luigi et al).…”