Prostate Cancer, Androgen Deprivation Therapy, Obesity, the Metabolic Syndrome, Type 2 Diabetes, and Cardiovascular Disease

Abstract

Prostate cancer is the most frequently diagnosed malignancy among UK men and accounts for 12% of male deaths. Androgen deprivation therapy (ADT) is commonly used as part of the treatment for prostate cancer. It is effective at suppressing prostate-specific antigen, stabilizing disease, alleviating symptoms in advanced disease, and potentially prolonging survival. However ADT, presumably at least in part owing to low testosterone levels is associated with insulin resistance, the development of metabolic syndrome plus increased overall and cardiovascular disease mortality. We have reviewed the relationship between prostate cancer, ADT, metabolic syndrome, type 2 diabetes, and cardiovascular disease. We have not reviewed other potential medical problems such as osteoporosis. We suggest that there should be a baseline assessment of patients' risk for cardiovascular disease before starting ADT. Consideration should be given to starting appropriate therapies including lifestyle advice, antihypertensive and lipid-lowering agents, insulin sensitizer, plus possibly aspirin. Having started ADT, the patients should have a regular (possibly annual) assessment of their cardiovascular risk factors.

Cancer-drug induced insulin resistance: Innocent bystander or unusual suspect

“…In ADT the activity of adrenal androgens is blocked using gonadotropin releasing hormone agonists, sometimes in combination with androgen receptor antagonists. Development of insulin resistance and metabolic syndrome are frequent side-effects, and patients are at increased risk of cardiovascular morbidity and mortality (Table 1) [48,49]. It is unclear whether the development of insulin resistance during ADT treatment influences outcome.…”

Dose‐dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events

“…Although others did not find an increase in cardiovascular mortality with the longer duration of ADT exposure [17], it is imperative that physicians who prescribe ADT understand its potential metabolic side effects. Patients need to be informed of the possible cardiac risk with ADT and should routinely perform prevention and undergo screening for cardiovascular disease [11,47].…”

Androgen deprivation of prostate cancer: Leading to a therapeutic dead end

“…Moreover, in some patients ADT is associated with depression or cognitive dysfunction, pneumonia, acute kidney injury, increased incidence of diabetes, and cardiovascular morbidity and mortality [9][10][11][12]. Therefore, predisposing factors of patients, such as a history of diabetes or cardiovascular events, have to be regarded before ADT initiation.…”