title: Androgen deprivation therapy complications.
abstract: Androgen deprivation therapy (ADT) is increasingly used to treat advanced prostate cancer and is also utilised as adjuvant or neo-adjuvant treatment for high-risk disease. The resulting suppression of endogenous testosterone production has deleterious effects on quality of life, including hot flushes, reduced mood and cognition and diminished sexual function. Cross-sectional and longitudinal studies show that ADT has adverse bone and cardio-metabolic effects. The rate of bone loss is accelerated, increasing the risk of osteoporosis and subsequent fracture. Fat mass is increased and lean mass reduced, and adverse effects on lipid levels and insulin resistance are observed, the latter increasing the risk of developing type 2 diabetes. ADT also appears to increase the risk of incident cardiovascular events, although whether it increases cardiovascular mortality is not certain from the observational evidence published to date. Until high-quality evidence is available to guide management, it is reasonable to consider men undergoing ADT to be at a higher risk of psychosexual dysfunction, osteoporotic fracture, diabetes and cardiovascular disease, especially when treated for extended periods of time and therefore subjected to profound and prolonged hypoandrogenism. Health professionals caring for men undergoing treatment for prostate cancer should be aware of the potential risks of ADT and ensure appropriate monitoring and clinical management.
authors.affiliation: MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia carolyn.allan@mimr-phi.org.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Allan
authors.affiliation: MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia.
authors.forename: Veronica R
authors.initials: VR
authors.lastname: Collins
authors.affiliation: MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Frydenberg
authors.affiliation: MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia.
authors.forename: Robert I
authors.initials: RI
authors.lastname: McLachlan
authors.affiliation: MIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, AustraliaMIMR-PHI Institute of Medical Research27-31 Wright Street, Clayton, Victoria 3168, AustraliaAndrology AustraliaSchool of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, AustraliaDepartment of EndocrinologyMonash Health, Melbourne, Victoria, AustraliaDepartments of Obstetrics and GynaecologySurgeryMonash University, Clayton, Victoria, AustraliaDepartment of UrologyMedical ProgramMonash Health, Melbourne, Victoria, Australia.
authors.forename: Kati L
authors.initials: KL
authors.lastname: Matthiesson
mesh_terms: D000339:Affect / Q000187:drug effects; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001862:Bone Resorption / Q000139:chemically induced; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D003071:Cognition / Q000187:drug effects; D019584:Hot Flashes / Q000139:chemically induced; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced
chemical_list: D000726:Androgen Antagonists; D000970:Antineoplastic Agents
keywords: androgen deprivation therapy; bone; cardiovascular disease; diabetes; fracture; osteoporosis; prostate cancer; quality of life