According to a new analysis and review of recent, published data, the “numerous well recognized adverse effects” of androgen deprivation therapy (ADT) include “vasomotor flushing, loss of libido and impotence, fatigue, gynecomastia, anemia, osteoporosis and metabolic complications, as well as effects on cardiovascular health and bone density.”
Conversely, of course, ADT has many well-recognized benefits when used in appropriate patients, and numerous trials have documented the benefits of ADT — alone and in combination with other forms of treatment.
Ahmadi and Daneshmand (of the USC Institute of Urology, USC/Norris Comprehensive Cancer Center at the University of Southern California) carried out a PubMed database search of all prospective clinical studies published between 2000 and 2012, including randomized and non-randomized clinical trials and meta-analysis studies concerning preventive and therapeutic interventions for the various side effects of ADT. They then used the highly regarded Oxford 2011 Levels of Evidence classification system to categorize selected studies according to the projected treatment benefits of the different possible interventions.
Here are their core findings:
- The drug gabapentin appears to have moderate efficacy for the long-term treatment of hot flashes.
- Combined resistance/aerobic exercise programs can lead to significant improvement in fatigue, sexual function and cognitive function.
- Home-based and/or group exercise programs can also improve fatigue and unfavorable metabolic changes.
- The drug denosumab can
- Increase bone mass density in the lumbar spine, hip, and radius
- Reduce risk for vertebral fractures in men receiving ADT for non-metastatic prostate cancer.
- The drug metformin, when used in conjunction with lifestyle interventions is a safe, well-tolerated intervention for adverse metabolic changes.
- The drug toremifene can be used to improve patients’ lipid profiles.
- Intermittent ADT improves early side effects, such as hot flashes, sexual activity, fatigue, and quality of life, although its effect on long-term side effects remains inconclusive.
The authors are, however, careful to add the following statement, with which The “New” Prostate Cancer InfoLink is in complete concurrence:
Despite significant improvement in management strategies for the side effects of ADT, the best way of preventing side effects is to use ADT only when it is absolutely indicated.
We have long felt that the greatest risk associated with the clinical application of ADT is when it is used too early — i.e., to manage PSA levels as opposed to actually managing real clinical issues — or for longer than it is actually needed.