Side effects of androgen deprivation therapy
- Matthew R Smith, MD, PhD
Matthew R Smith, MD, PhD
- Professor of Medicine
- Harvard Medical School
- Massachusetts General Hospital Cancer Center
- E David Crawford, MD
E David Crawford, MD
- Professor of Surgery, Urology and Radiation Oncology
- University of Colorado Denver School of Medicine
- Section Editors
- Nicholas Vogelzang, MD
Nicholas Vogelzang, MD
- Section Editor — Prostate Cancer
- Professor of Medicine
- University of Nevada School of Medicine
- US Oncology Research
- W Robert Lee, MD, MS, MEd
W Robert Lee, MD, MS, MEd
- Section Editor — Prostate Cancer
- Professor of Radiation Oncology
- Duke University Medical Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
Androgen deprivation therapy (ADT) is the main therapeutic approach for men with metastatic prostate cancer. ADT is also frequently used in patients whose only manifestation of disseminated disease is a rising or elevated serum PSA and as adjuvant or neoadjuvant therapy in conjunction with initial treatment of men with intermediate or high risk prostate cancer. (See "Initial systemic therapy for castration sensitive prostate cancer" and "Initial management of regionally localized intermediate, high, and very high-risk prostate cancer" and "Rising serum PSA after treatment for localized prostate cancer: Systemic therapy".)
Despite the potential benefits associated with its use, ADT can cause a range of side effects that negatively affect quality of life and may necessitate a change in therapy. The side effects of hormone therapy for prostate cancer, their prevention and management, and the potential role of an alternative hormonal strategy are discussed here.
The vast majority of men receiving continuous ADT who are potent prior to therapy develop sexual dysfunction. Loss of libido in men receiving gonadotropin-releasing hormone (GnRH) agonists usually develops within the first several months, and erectile dysfunction follows. Sexual dysfunction should be anticipated and couples counseled before ADT is started. Sex therapists may be helpful in managing these issues once they become problematic.
Recovery of erectile function is possible after discontinuation of short-term ADT (eg, in men who receive neoadjuvant and adjuvant ADT with radiation therapy for high-risk localized or locally advanced disease). However, it may be delayed and incomplete .
OSTEOPOROSIS AND BONE FRACTURES
ADT increases bone turnover, decreases bone mineral density, and increases the risk of bone fractures in men with prostate cancer . Loss of bone mineral density can be detected after six to nine months of ADT, and longer therapy confers a higher risk [3-6]. Osteoporotic skeletal fractures occur in up to 20 percent of men within five years of starting ADT [3,7].
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- SEXUAL DYSFUNCTION
- OSTEOPOROSIS AND BONE FRACTURES
- - Lifestyle modification
- - Osteoclast inhibition
- VASOMOTOR SYMPTOMS
- - Alternative strategies
- BODY COMPOSITION AND METABOLISM
- POTENTIAL CARDIOVASCULAR HARM
- Cardiac disease
- Venous thromboembolism
- KIDNEY INJURY
- ISSUES RELATED TO BODY IMAGE
- Decreased penile and testicular size
- Thinning of body hair
- EMOTIONAL AND COGNITIVE CHANGES
- ROLE OF STRUCTURED EXERCISE
- ALTERNATIVE HORMONE STRATEGIES
- Antiandrogen monotherapy
- Intermittent androgen deprivation