Metabolic Complications of Androgen Deprivation Therapy for the Treatment of Prostate Cancer

Abstract

Aim: Prostate cancer is the most commonly diagnosed cancer and second leading cause of cancer death in U.S. men. The b median age at diagnosis is 67 years, with black men having a 50% higher risk of developing prostate cancer and two-fold mortality rate compared with Caucasians. The use of androgen deprivation therapy (ADT) is associated with symptom control in patients with metastatic prostate cancer but no known survival advantage. This therapy has significant impact on skeletal health, but more recently, the metabolic complications of ADT have been recognized. These include obesity, insulin resistance, diabetes, lipid alterations and cardiovascular health, which will be the focus of this review. Method: We performed a PubMed search (1950-2014) of articles written in English using search terms including prostate cancer, androgen deprivation therapy, gonadotropin-releasing hormone agonists, insulin resistance, diabetes, and cardiovascular disease. Result: Due to the general indolence of prostate cancer in older men, many will live with the consequences of cancer-related treatment, particularly the acquired hypogonadism related to use of ADT. Androgen deprivation therapy decreases lean mass and increases fat mass. It also decreases insulin sensitivity while increasing low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglycerides. These translate to greater incidence of diabetes, cardiovascular and skeletal disease. Conclusion: Approximately 33-70% of men with prostate cancer will undergo treatment with ADT at some point in the treatment of their disease. Hence, it is important for physicians and patients to consider the metabolic consequences such as risk of diabetes and cardiovascular disease, and balance it against the potential benefits of therapy when making treatment decisions about ADT. In the absence of high level evidence, we recommend following well established guidelines on screening, prevention and management of these effects as in the general population.