Prostate cancer survivorship: prevention and treatment of the adverse effects of androgen deprivation therapy.
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.


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.


CONCLUSIONS
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.
Division of Hematology-Oncology, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital Lawrence House/POB, 55 Fruit Street, Boston, MA 02114, USA. psaylor@partners.org
Philip J
PJ
Saylor
Nancy L
NL
Keating
Matthew R
MR
Smith
D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000401:mortality / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000517:prevention & control; D050723:Fractures, Bone / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends
D000726:Androgen Antagonists