scholarly journals Cardiovascular and Metabolic Effects of Androgen-Deprivation Therapy for Prostate Cancer

2018 ◽  
Vol 14 (10) ◽  
pp. 580-587 ◽  
Author(s):  
Dipti Gupta ◽  
Katherine Lee Chuy ◽  
Ji Can Yang ◽  
Megan Bates ◽  
Marissa Lombardo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Cardiovascular Events ◽  
Advanced Prostate Cancer ◽  
Serum Testosterone ◽  
Management Plan ◽  
Androgen Deprivation ◽  
Metabolic Effects ◽  
Increased Risk ◽  
Hormone Sensitive

Androgen-deprivation therapy (ADT) entails lowering serum testosterone levels to castrate levels and forms a cornerstone of the management of hormone-sensitive advanced prostate cancer; however, the benefit of ADT is partially offset by its detrimental metabolic and cardiovascular adverse effects. ADT decreases insulin sensitivity while promoting dyslipidemia and sarcopenic obesity, which leads to an increased risk of cardiovascular morbidity and potentially mortality. The risk seems to be highest in elderly patients who have had recent cardiovascular events before starting ADT. It is prudent to engage in an individualized risk–benefit discussion and develop a cohesive multidisciplinary management plan to medically optimize and closely observe these patients before and during treatment with ADT.

scholarly journals The modern role of androgen deprivation therapy in the management of localised and locally advanced prostate cancer

2016 ◽  
Vol 9 (2_suppl) ◽  
pp. 24-29 ◽  
Author(s):  
Charlotte Gunner ◽  
Aziz Gulamhusein ◽  
Derek J Rosario
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Androgen Deprivation ◽  
Locally Advanced Prostate Cancer ◽  
Curative Intent ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk

Introduction: Approximately 50% of men diagnosed with prostate cancer will be exposed to androgen deprivation therapy (ADT) at some stage. The role of ADT in the management of metastatic disease has long been recognised, and its place in the management of localised and locally advanced disease has become clearer in the past few years. Nevertheless, concerns remain that some men might not benefit from ADT in earlier-stage disease. The purpose of the current article is to provide a brief narrative review of the role of ADT as part of a strategy of treatment with curative intent, concentrating mainly on key recent developments in the area. Methods: Narrative literature review of key publications in the English language relating to ADT in the management of localised and locally advanced prostate cancer. Results: In locally advanced and high-risk localised prostate cancer, the use of ADT in combination with radiotherapy improves disease-specific and overall survival. There is no evidence to support the use of ADT in the treatment of low-risk localised prostate cancer. There appears to be an increased risk of cardiovascular morbidity and mortality associated with luteinizing hormone-releasing hormone agonists, particularly in men with pre-existing cardiovascular disease, but the relevance of this in the adjuvant/neoadjuvant setting is currently unclear. Conclusions: Future studies should focus on identification of men who are at risk from cardiovascular complications associated with ADT and on the comparison of radiotherapy with ADT versus surgery in the management of localised and locally advanced prostate cancer, particularly with regards to men with pre-existing comorbidities.

Network metanalysis and cost-effectiveness of abiraterone, docetaxel or placebo plus androgen deprivation therapy (ADT) for hormone-sensitive advanced prostate cancer.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 6615-6615
Author(s):  
Pedro Nazareth Aguiar ◽  
Pui San Tan ◽  
Sarah Simko ◽  
CARMELIA MARIA NOIA BARRETO ◽  
Barbara Gutierres Aguiar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Androgen Deprivation Therapy ◽  
Advanced Prostate Cancer ◽  
Androgen Deprivation ◽  
Hormone Sensitive

scholarly journals Testosterone monitoring for men with advanced prostate cancer: Review of current practices and a survey of Canadian physicians

2017 ◽  
Vol 11 (6) ◽  
pp. 204 ◽  
Author(s):  
Bobby Shayegan ◽  
Frédéric Pouliot ◽  
Alan So ◽  
John Fernandes ◽  
Joseph Macri
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Testosterone Level ◽  
Advanced Prostate Cancer ◽  
Standard Of Care ◽  
Androgen Deprivation ◽  
Testosterone Levels ◽  
Radiation Oncologists ◽  
Cancer Review ◽  
Hormone Sensitive

Androgen-deprivation therapy (ADT) is a standard of care in the treatment of advanced prostate cancer; however, testosterone monitoring practices for men undergoing ADT vary across Canada. Although a testosterone level of 1.7 nmol/L or lower has historically been defined as the accepted castrate level, newer assays with improved sensitivity have shown that both medical and surgical castration can suppress testosterone levels to below 0.7 nmol/L. This review explores the evidence supporting a redefinition of the castrate testosterone level as 0.7 nmol/L or lower, and presents results of a survey of testosterone monitoring practices among 153 Canadian urologists, uro-oncologists, and radiation oncologists who manage the treatment of men with hormone-sensitive prostate cancer.

scholarly journals Prostate Carcinogenesis with Diabetes and Androgen-Deprivation-Therapy-Related Diabetes: An Update

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Noboru Hara
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Relevant Literature ◽  
Serum Testosterone ◽  
The United States ◽  
Population Based ◽  
Androgen Deprivation ◽  
Prostate Carcinogenesis ◽  
Increased Risk

Prostate cancer and the androgen deprivation therapy (ADT) thereof are involved in diabetes in terms of diabetes-associated carcinogenesis and ADT-related metabolic disorder, respectively. The aim of this study is to systematically review relevant literature. About 218,000 men are estimated to be newly diagnosed with prostate cancer every year in the United States. Approximately 10% of them are still found with metastasis, and in addition to them, about 30% of patients with nonmetastatic prostate cancer recently experience ADT. Population-based studies have shown that dissimilar to other malignancies, type 2 diabetes is associated with a lower incidence of prostate cancer, whereas recent large cohort studies have reported the association of diabetes with advanced high-grade prostate cancer. Although the reason for the lower prevalence of prostate cancer among diabetic men remains unknown, the lower serum testosterone and PSA levels in them can account for the increased risk of advanced disease at diagnosis. Meanwhile, insulin resistance already appears in 25–60% of the patients 3 months after the introduction of ADT, and long-term ADT leads to a higher incidence of diabetes (reported hazard ratio of 1.28–1.44). Although the possible relevance of cytokines such as Il-6 and TNF-αto ADT-related diabetes has been suggested, its mechanism is poorly understood.

scholarly journals An update on androgen deprivation therapy for prostate cancer

2010 ◽  
Vol 17 (4) ◽  
pp. R305-R315 ◽  
Author(s):  
Nima Sharifi ◽  
James L Gulley ◽  
William L Dahut
Keyword(s):  
Prostate Cancer ◽  
Clinical Trials ◽  
Androgen Deprivation Therapy ◽  
Cardiovascular Mortality ◽  
Randomized Study ◽  
Androgen Deprivation ◽  
Metabolic Effects ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Increased Risk

Androgen deprivation therapy (ADT) with gonadal testosterone depletion is the frontline treatment for advanced prostate cancer. Other hormonal interventions have a role in the treatment of prostate cancer. We sought to examine systematically the evidence for hormonal interventions in prostate cancer, risks of ADT, and interventions that mitigate these risks. Search results for therapeutic studies were focused primarily on randomized controlled clinical trials, and the Jadad scale criteria were used to evaluate the quality of these studies. Four trials of the efficacy of intermittent ADT versus continuous ADT were included. One randomized study analysis and six postrandomization analyses were included on the effects of ADT on cardiovascular mortality. Seven randomized controlled trials of pharmacologic interventions were included for the treatment of metabolic effects due to ADT. One randomized trial of GnRH antagonist versus GnRH agonist was included. Six phase I/II clinical trials of secondary hormonal therapies with novel mechanisms of action were included. Randomized studies completed to date indicate that intermittent ADT might be equivalent to continuous ADT. Although adverse effects of ADT include risk factors for cardiovascular disease, effects on cardiovascular mortality are uncertain. Bone loss and increased risk of fracture may be effectively treated with pharmacologic interventions. Benefits of ADT must be balanced with a consideration of the risks.

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