58 - Effects of Hormone Deprivation in Survivors of Breast and Prostate Cancer

Abstract

Prostate and breast cancers are among the most successfully treated malignancies with the largest numbers of survivors. As the number of cancer survivors grows, the long-term side effects of treatment play an increasingly prominent role in the routine care of these patients. This chapter discusses the issues faced by cancer survivors as well as the information about the evaluation and treatment of conditions affecting the quality of life (QOL) of these patients. There are many issues facing survivors of breast and prostate cancer treatment with implications for the ongoing primary care of these patients. Many of these issues center on hormonal changes associated with the cancer treatment and require special attention to the conditions caused by sex hormone deprivation. Breast cancer treatment frequently causes premature ovarian failure, which results in prolonged estrogen deprivation and thereby increases the risks of osteoporosis, cardiovascular disease, menopausal symptoms, cognitive dysfunction, and weight gain. For men with prostate cancer, bilateral orchiectomy or hormonal therapy with gonadotropin-releasing hormone (GnRH) agonists are the standard of care for patients with metastatic disease. Evidence suggests that earlier hormone therapy may prolong survival in these patients. Although androgen deprivation therapy is successful in controlling prostate cancer, there are both short- and long-term consequences of this therapy. Short-term side effects include hot flashes and decreased libido; long-term consequences include decline in muscle mass, gynecomastia, osteoporosis, and QOL.