Abstract
The prostate is an androgen-dependent organ. The increase, growth, homeostasis, and function of the prostate largely depend upon the intraprostatic and serum concentrations of androgens. Therefore, androgens are essential for the physiologic growth of prostatic epithelium. Prostate cancer, the second leading cause of death for men, is also androgen dependent, and androgen suppression is the mainstay of treatment for advanced and metastatic disease. In the state of metastatic disease, androgen suppression is a palliative treatment leading to a median progression-free survival of 18–20 months and an overall survival of 24–36 months. Theoretically, the majority of patients will develop hormone-refractory disease provided that they will not die from other causes. Although androgen suppression therapy may be associated with significant and sometimes durable responses, it is not considered a cure, and its potential efficacy is further limited by an array of significant and bothersome adverse effects caused by the suppression of androgens. These effects have potentially significant consequences on a variety of parameters of everyday living and may further decrease health-related quality of life. This review focuses on the aetiology of these adverse effects and provides information on their prevention and management.
Highlights
It is estimated that there are nearly 2.8 million men living with a history of prostate cancer in the USA, and an additional 241,740 cases will be diagnosed in 2012 [1]
Androgen deprivation therapy (ADT) indications are limited to the palliation of symptomatic metastases, ADT is widely used in men with biochemical (PSA) relapse after radical prostatectomy, locally advanced disease, lymph node metastases, and asymptomatic metastatic disease [2, 3]
ADT is commonly used in combination with external beam radiotherapy (EBRT) for intermediate to high-risk prostate cancer cases in order to improve responses to radiotherapy [4]
Summary
It is estimated that there are nearly 2.8 million men living with a history of prostate cancer in the USA, and an additional 241,740 cases will be diagnosed in 2012 [1]. Additional evidence in support of early treatment initiation was provided by the Medical Research Council study of 938 patients with locally advanced or asymptomatic metastatic prostate cancer. While sexual side effects including loss of libido and erectile dysfunction are well recognized and anticipated, changes in body composition (gynecomastia, weight gain, reduced muscle mass and muscle tone, and increase in abdominal fat), cognitive defects (memory loss) and metabolic disturbances (hyperglycemia, altered lipoprotein profile, decreased insulin sensitivity, and osteoporosis) are less commonly recognized side effects of ADT Both the diagnosis of prostate cancer and ADT itself can negatively affect psychosocial well-being and cause distress. Physicians should be aware of far-reaching consequences of ADT and should incorporate strategies for preventing and managing toxicities into routine practice [8]
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