Platinum Priority – Collaborative Review – Prostate CancerEditorial by Fred Saad on pp. 837–838 of this issueAdverse Effects of Androgen Deprivation Therapy and Strategies to Mitigate Them☆
Introduction
Androgen deprivation therapy (ADT) is a mainstay of prostate cancer treatment and has been shown in randomized trials to improve overall survival when used with radiation for intermediate- and high-risk localized disease [1], [2], as well as locally advanced [3], [4] and node-positive disease [5], and after surgery for node-positive disease [6]. Although ADT can improve survival, it can also cause significant morbidity and a decrement in quality of life (QOL). This narrative review describes the adverse consequences of ADT and provides an up-to-date summary of evidence-based interventions that can prevent or reduce these side effects (Table 1, Table 2).
Section snippets
Evidence acquisition
A Medline search was conducted to identify original articles and review articles published from January 1, 1966, to August 1, 2013, that focused on the side effects of ADT and methods to mitigate those side effects. Keywords included androgen deprivation therapy and side effects. The articles with the highest level of evidence within each of the side effect categories examined were identified with the consensus of all of the collaborative authors and were reviewed. For the treatment of
Impact of androgen deprivation therapy on bone health and strategies for prevention
ADT is associated with decreases in bone mineral density (BMD) and increased risk of fracture. Prospective studies suggest that BMD decreases by 5–10% in the first year after initiating ADT for prostate cancer [7], [8], [9], [10]. Two studies based on the Surveillance Epidemiology and End Results (SEER)–Medicare database reported an increased fracture risk with ADT that increased with longer duration of ADT. One study noted a 21% relative increase in clinical fractures with ADT use [11], and
Conclusions
Although ADT can improve survival for men in certain settings, ADT also has a variety of potential harms. Methods of preventing bone loss are now well established, and exercise may prove to be a good way to reduce the body composition changes and fatigue from ADT, but these results will require further confirmation. For several other side effects, there are presently no effective mitigating interventions. At this point, the only certain way to prevent many of the adverse effects is to avoid
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