Androgen Deprivation Therapy in Prostate Cancer and Metabolic Risk for Atherosclerosis

Abstract Context: Prostate cancer (PCa) is the most common cancer in men. Androgen-deprivation therapy (ADT) is generally employed in the treatment of locally advanced and metastatic PCa. Although its use as an adjuvant therapy has resulted in improved survival in some patients, ADT has negative consequences. Complications like osteoporosis, sexual dysfunction, gynecomastia, and adverse body composition are well known. Recently, metabolic complications like insulin resistance, diabetes, dyslipidemia, and metabolic syndrome have emerged, which may be responsible for the increased cardiovascular mortality in this population. Evidence Acquisition: A MEDLINE search was conducted for articles published over the last 20 yr based on the key words androgen deprivation therapy AND insulin resistance, hyperglycemia, diabetes, dyslipidemia, metabolic syndrome, and cardiovascular disease. Relevant studies in non-PCa populations evaluating the association between testosterone and metabolism were also reviewed and briefly mentioned where relevant. Evidence Synthesis: Prospective studies evaluating early (3–6 months) metabolic changes of ADT show development of hyperinsulinemia; however, glucose levels remain normal. Cross-sectional studies of men undergoing long-term (≥12 months) ADT reveal higher prevalence of diabetes and metabolic syndrome compared with controls. Furthermore, men undergoing ADT also experience higher cardiovascular mortality. Conclusion: Long-term prospective studies of ADT are needed to determine the timing of onset of these metabolic complications and to investigate the mechanism behind them. In the meantime, we recommend baseline and serial screening for fasting glucose, lipids, and other cardiovascular risk factors in men receiving ADT. Glucose tolerance tests and cardiac evaluation may be required in selected cases.

Download Full-text

Androgen Deprivation Therapy for Prostate Cancer Does Not Increase Cardiovascular Mortality in the Long Term

Oncology ◽

10.1159/000334999 ◽

2012 ◽

Vol 82 (1) ◽

pp. 56-58 ◽

Cited By ~ 18

Author(s):

Chantelle Wilcox ◽

Allison Kautto ◽

Allison Steigler ◽

James W. Denham

Keyword(s):

Prostate Cancer ◽

Androgen Deprivation Therapy ◽

Cardiovascular Mortality ◽

Androgen Deprivation

Download Full-text

Metabolic syndrome in patients with prostate cancer undergoing intermittent androgen-deprivation therapy

Canadian Urological Association Journal ◽

10.5489/cuaj.3655 ◽

2016 ◽

Vol 10 (9-10) ◽

pp. 300 ◽

Cited By ~ 13

Author(s):

Mohammadali Mohammadzadeh Rezaei ◽

Mohammadhadi Mohammadzadeh Rezaei ◽

Alireza Ghoreifi ◽

Behzad Feyzzadeh Kerigh

Keyword(s):

Prostate Cancer ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation ◽

Safe Alternative ◽

Metabolic Complications ◽

The Metabolic Syndrome ◽

Increased Risk ◽

Blood Pressures

Introduction: The presence of metabolic syndrome in men with prostate cancer (PCa) undergoing androgen-deprivation therapy (ADT), especially intermittent type, has not been completely evaluated. The aim of this study is to evaluate metabolic syndrome in men with PCa undergoing intermittent ADT.Methods: In this longitudinal study, we studied the prevalence of metabolic syndrome and its components in 190 patients who were undergoing intermittent ADT. The metabolic syndrome was defined according to the Adult Treatment Panel III criteria. All metabolic parameters, including lipid profile, blood glucose, blood pressures, and waist circumferences of the patients were measured six and 12 months after treatment.Results: Mean age of the patients was 67.5 ± 6.74 years. The incidence of metabolic syndrome after six and 12 months was 6.8% and 14.7%, respectively. Analysis of various components of the metabolic syndrome revealed that patients had significantly higher overall prevalence of hyperglycemia, abdominal obesity, and hypertriglyceridemia in their six- and 12-month followups, but blood pressure has not been changed in the same period except for diastolic blood pressure after six months.Conclusions: Although there was an increased risk of metabolic syndrome in patients receiving intermittent ADT, it was lower than other studies that treated the same patients with continuous ADT. Also it seems that intermittent ADT has less metabolic complications than continuous ADT and could be used as a safe alternative in patients with advanced and metastatic PCa.

Download Full-text

Faculty Opinions recommendation of Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718357919.793494152 ◽

2014 ◽

Author(s):

Thomas Flaig

Keyword(s):

Prostate Cancer ◽

Metabolic Syndrome ◽

Androgen Deprivation Therapy ◽

Androgen Deprivation

Download Full-text

Metabolic Syndrome in Men With Prostate Cancer Undergoing Long-Term Androgen-Deprivation Therapy

Journal of Clinical Oncology ◽

10.1200/jco.2006.05.9741 ◽

2006 ◽

Vol 24 (24) ◽

pp. 3979-3983 ◽

Cited By ~ 373

Author(s):

Milena Braga-Basaria ◽

Adrian S. Dobs ◽

Denis C. Muller ◽

Michael A. Carducci ◽

Majnu John ◽

...

Keyword(s):

Prostate Cancer ◽

Metabolic Syndrome ◽

Androgen Deprivation Therapy ◽

Abdominal Obesity ◽

Local Treatment ◽

Androgen Deprivation ◽

Control Group ◽

Male Hypogonadism ◽

And Control

Purpose Prostate cancer (PCa) is one of the most common cancers in men. Men with recurrent or metastatic PCa are treated with androgen-deprivation therapy (ADT), resulting in profound hypogonadism. Because male hypogonadism is a risk factor for metabolic syndrome and men with PCa have high cardiovascular mortality, we evaluated the prevalence of metabolic syndrome in men undergoing long-term ADT. Patients and Methods This was a cross-sectional study. We evaluated 58 men, including 20 with PCa undergoing ADT for at least 12 months (ADT group), 18 age-matched men with nonmetastatic PCa who had received local treatment and were recently found to have an increasing prostate-specific antigen (non-ADT group), and 20 age-matched controls (control group). Men in the non-ADT and control groups were eugonadal. Metabolic syndrome was defined according to the Adult Treatment Panel III criteria. Results Mean age was similar among the groups. Men on ADT had significantly higher body mass index and lower total and free testosterone levels. The prevalence of metabolic syndrome was higher in the ADT group compared with the non-ADT (P < .01) and control (P = .03) groups. Among the components of metabolic syndrome, men on ADT had a higher prevalence of abdominal obesity and hyperglycemia. Androgen-deprived men also had elevated triglycerides compared with controls (P = .02). The prevalence of hypertension and low high-density lipoprotein levels were similar. Conclusion These data suggest that metabolic syndrome was present in more than 50% of the men undergoing long-term ADT, predisposing them to higher cardiovascular risk. Abdominal obesity and hyperglycemia were responsible for this higher prevalence. We recommend prospective studies to further delineate this association.

Download Full-text