Androgen deprivation therapy: evidence-based management of side effects.

[JimJimJimJim]

Jim Marshall (not a doctor) said ... 

Most men with advanced prostate cancer have Androgen Deprivation Therapy (ADT, hormone therapy) as part of their treatment.

 

Most commonly it consists of an LHRH agonist such as:

• Zoladex (Goserelin), Lupron (leuprorelin), Eligard (leuprolide), Lucrin (leuprorelin acetate),  Suprefact (buserelin), Suprecor (buserelin), Synarel (nafarelin), histrelin (Supprelin), Suprelorin (deslorelin), Ovuplant(deslorelin), Triptorelin),
  

plus, perhaps, an anti-androgen such as:

• Cosudex/Casodex (bicalutamide), Anandron/ Nilandron (Nilutamide), Eulexin (Flutamide), all nonsteroidal, and Androcur (Cyproterone, a steroid), Nizoral (Ketoconazole), and sometimes Zytiga (abiraterone acetate) and Xtandi (enzalutamide) are regarded as anti-androgens.
  

Less commonly it may consist of the LHRH antagonist Abarelix, Firmagon (degarelix) alone.

 

 ADT is used because it has been shown to be effective in slowing the disease in many men.

 

However, it has its negative side – the side effects.

 

The authors of the article below trolled through enormous numbers of research papers to find the most common side effects, and to find evidence based treatments for these side effects.

 

The possible side effects: 

• vasomotor flushing (hot flushes or hot flashes, 
  
• loss of libido (desire for sex),
  
• impotence (loss of erection),
  
• fatigue
  
•  gynaecomastia (breast enlargement),
  
• anaemia (when the blood does not have enough iron) ,
  
• osteoporosis (thinning of the bones)
  
• metabolic complications, as well as effects on cardiovascular health.
  

 

The treatments:

• They conclude that the best way of preventing side effects is to use ADT only when it is absolutely indicated.
  
• Gabapentin shows moderate efficacy for the long-term treatment of hot flashes. 
  
• A combined resistance/aerobic exercise programme leads to significant improvement in fatigue, sexual function and cognitive function. 
  
• A home-based/group exercise programme also improves fatigue and unfavourable metabolic changes. 
  
• Denosumab increases lumbar spine, hip and radius bone mass density, and also reduces the risk of vertebral fractures in men receiving ADT for non-metastatic prostate cancer. 
  
• Metformin coupled with lifestyle intervention is a safe, well-tolerated intervention for adverse metabolic changes.
  
•  Toremifene improves the lipid profile.
  

If you experience side effects, or are worried about these, you may wish to discuss these with your doctor.

... end Jim

 

BJU Int. 2013 Jan 25. doi: 10.1111/j.1464-410X.2012.11774.x. [Epub ahead of print]

Androgen deprivation therapy: evidence-based management of side effects.

Ahmadi H, Daneshmand S.

Source

USC Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.

Abstract

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: The benefits of androgen deprivation therapy (ADT) are well recognized and a multitude of studies have documented the benefits of ADT in conjunction with other therapies. Given the widespread use of ADT due to its important clinical implications, it is imperative that clinicians understand the side effects to limit treatment-related morbidity. There are numerous well recognized adverse effects of ADT, including vasomotor flushing, loss of libido and impotence, fatigue, gynaecomastia, anaemia, osteoporosis and metabolic complications, as well as effects on cardiovascular health and bone density. Present study focuses on the most recent evidence-based treatment options for various side effects of ADT.

OBJECTIVE:

To familiarize clinicians with the various side effects of androgen deprivation therapy (ADT). The present study focuses on the most recent evidence-based treatment strategies for the common side effects of ADT.

METHODS:

A PubMed database search was conducted from 2000 to 2012. All prospective clinical studies were selected, including randomized and non-randomized clinical trials, as well as meta-analysis studies concerning preventive and therapeutic interventions for various side effects of ADT. 'The Oxford 2011 Levels of Evidence' classification system for treatment benefits was used to categorize selected studies.

RESULTS:

Gabapentin shows moderate efficacy for the long-term treatment of hot flashes in a dose-dependent manner. A combined resistance/aerobic exercise programme leads to significant improvement in fatigue, sexual function and cognitive function. A home-based/group exercise programme also improves fatigue and unfavourable metabolic changes. Denosumab increases lumbar spine, hip and radius bone mass density, and also reduces the risk of vertebral fractures in men receiving ADT for non-metastatic prostate cancer. Metformin coupled with lifestyle intervention is a safe, well-tolerated intervention for adverse metabolic changes. Toremifene improves the lipid profile. 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.

CONCLUSION:

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.

© 2013 BJU International.

PMID: 23351025