Cardiovascular and Metabolic Effects of Androgen-Deprivation Therapy for Prostate Cancer

Abstract

Androgen-deprivation therapy (ADT) entails lowering serum testosterone levels to castrate levels and forms a cornerstone of the management of hormone-sensitive advanced prostate cancer; however, the benefit of ADT is partially offset by its detrimental metabolic and cardiovascular adverse effects. ADT decreases insulin sensitivity while promoting dyslipidemia and sarcopenic obesity, which leads to an increased risk of cardiovascular morbidity and potentially mortality. The risk seems to be highest in elderly patients who have had recent cardiovascular events before starting ADT. It is prudent to engage in an individualized risk-benefit discussion and develop a cohesive multidisciplinary management plan to medically optimize and closely observe these patients before and during treatment with ADT.Careful history taking and physical examination to diagnose, treat, and optimize active CV disease with guideline-directed therapy before starting androgen-deprivation therapyConsider metformin for diabetes, ACEIs for HTN, aspirin for vascular health, and statins for hyperlipidemia in eligible patientsSmoking cessation, lifestyle modification, exercise, and stress reduction must be emphasized in all patients Awareness to seek immediate medical attention for new or worsening CV symptoms Abbreviations: ACEI, angiotension-converting enzyme inhibitor; CV, cardiovascular; HTN, hypertension.

Exercise duRing Active Surveillance for prostatE cancer—the ERASE trial: a study protocol of a phase II randomised controlled trial

“…In addition, cardiorespiratory fitness has important clinical implications for cardiovascular and overall prognosis of PCa 69. PCa patients are at a higher risk of cardiovascular morbidity71 72 and mortality72 73 and are three times more likely to die of cardiovascular disease than of PCa 6. Cardiorespiratory fitness is an established surrogate marker for cardiovascular disease and overall survival74 75 and impaired cardiopulmonary fitness, commonly reported among cancer patients, is correlated with cancer-related symptoms and clinical outcomes 76.…”

A practical guide to endocrine therapy in the management of estrogen receptor-positive male breast cancer

“…In the rare instance that orchiectomy is offered, the psychological impact of the procedure should be taken into consideration. Prolonged GnRHa use in men has been associated with changes in metabolic states including hyperinsulinemia, hypercholesterolemia and increase in body fat [45], and is associated with an increased risk of myocardial infarction and stroke [46][47][48].…”

Relationship between Circulating Lipids and Cytokines in Metastatic Castration-Resistant Prostate Cancer

“…Patients continue taking ADT while undergoing additional treatment for mCRPC. ADT can cause adverse cardiovascular or metabolic effects such as decreased insulin sensitivity, increased levels of blood cholesterol and triglycerides, decreased lean mass, and increased fat mass [ 2 ].…”