Clinical Review

Journal of General Internal Medicine

, Volume 24, Issue 2, pp 389-394

Open Access This content is freely available online to anyone, anywhere at any time.

Prostate Cancer Survivorship: Prevention and Treatment of the Adverse Effects of Androgen Deprivation Therapy

  • Philip J. SaylorAffiliated withDivision of Hematology-Oncology, Massachusetts General Hospital Cancer Center Email author 
  • , Nancy L. KeatingAffiliated withDivision of General Internal Medicine, Brigham and Women’s Hospital and Department of Health Care Policy, Harvard Medical School
  • , Matthew R. SmithAffiliated withDivision of Hematology-Oncology, Massachusetts General Hospital Cancer Center

ABSTRACT

BACKGROUND

More than one-third of the estimated 2 million prostate cancer survivors in the United States receive androgen deprivation therapy (ADT). This population of mostly older men is medically vulnerable to a variety of treatment-associated adverse effects.

MEASUREMENTS AND RESULTS

Androgen-deprivation therapy (ADT) causes loss of libido, vasomotor flushing, anemia, and fatigue. More recently, ADT has been shown to accelerate bone loss, increase fat mass, increase cholesterol and triglycerides, and decrease insulin sensitivity. Consistent with these adverse metabolic effects, ADT has also recently been associated with greater risks for fractures, diabetes and cardiovascular disease.

CONCLUSION

Primary care clinicians and patients should be aware of the potential benefits and harms of ADT. Screening and intervention to prevent treatment-related morbidity should be incorporated into the routine care of prostate cancer survivors. Evidence-based guidelines to prevent fractures, diabetes, and cardiovascular disease in prostate cancer survivors represent an important unmet need. We recommend the adapted use of established practice guidelines designed for the general population.

KEY WORDS

prostate cancer survivorship GnRH agonists osteoporosis bisphosphonates diabetes obesity cardiovascular disease