LHRH analog therapy is associated with worse metabolic side effects than bilateral orchiectomy in prostate cancer.

Abstract

The morbidity associated with metabolic syndrome induced by androgen deprivation therapy (ADT) in prostate cancer (PCa) has not been widely studied. There are no studies comparing surgical and pharmacological castration with regards to their metabolic side effects. The aim of this study was to compare both modalities. A prospective observational study was conducted in men with PCa and with indications of any ADT. The participants were divided into two groups: (1) bilateral orchiectomy and (2) LHRH analogs. The metabolic profile was assessed before and during the period of ADT. Bioelectrical impedance analysis (BIA) and bone mineral density were measured before and after 6months of treatment. The data were analyzed using the Chi-squared test, Student's t test, Bonferroni's test, and ANOVA. We enrolled 102 men for analysis, of whom 46 (54.9%) had been subjected to bilateral orchiectomy and 56 (54.9%) had been subjected to treatment with LHRH analogs. The basal metabolic profile, body mass index, and BIA were similar between the two groups. The oncologic control (PSA and testosterone) was also similar in both groups. In the intergroup comparison, insulin resistance (p=0.044) and hemoglobin (p=0.001) were worse in the group that used LHRH analogs, which was mainly diabetic patients (p=0.007). This study showed that LHRH analogs had worse effects relative to insulin resistance, mainly in diabetic patients, and induced more anemia and bone demineralization compared to surgical castration. Further prospective, randomized, and comparative studies are needed for metabolic syndrome in ADT modalities.