Metabolic Complications of Androgen Deprivation Therapy for Prostate Cancer

No AccessJournal of UrologySpecial Article1 May 2009Metabolic Complications of Androgen Deprivation Therapy for Prostate Canceris companion ofMetabolic Complications of Androgen Deprivation Therapy for Prostate Cancer Philip J. Saylor and Matthew R. Smith Philip J. SaylorPhilip J. Saylor and Matthew R. SmithMatthew R. Smith View All Author Informationhttps://doi.org/10.1016/j.juro.2009.01.047AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Androgen deprivation therapy has a variety of well recognized adverse effects including vasomotor flushing, loss of libido, fatigue, gynecomastia, anemia and osteoporosis. This review focuses on the more recently described metabolic complications of androgen deprivation therapy including obesity, insulin resistance and lipid alterations as well as the association of androgen deprivation therapy with diabetes and cardiovascular disease. Materials and Methods: We reviewed the medical literature using the PubMed® search terms prostate cancer, androgen deprivation therapy, gonadotropin-releasing hormone agonists, obesity, insulin resistance, lipids, diabetes, cardiovascular disease and myocardial infarction. We provide a focused review and our perspective on the relevant literature. Results: 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. Consistent with these adverse metabolic effects, androgen deprivation therapy may be associated with a greater incidence of diabetes and cardiovascular disease. Some of these androgen deprivation therapy related metabolic changes (obesity, insulin resistance and increased triglycerides) overlap with features of the metabolic syndrome. However, in contrast to the metabolic syndrome, androgen deprivation therapy increases subcutaneous fat and high density lipoprotein cholesterol. Conclusions: Androgen deprivation therapy increases obesity, decreases insulin sensitivity and adversely alters lipid profiles. It may be associated with a greater incidence of diabetes and cardiovascular disease. The benefits of androgen deprivation therapy should be weighed against these and other potential harms. Little is known about the optimal strategy to mitigate the adverse metabolic effects of androgen deprivation therapy. Thus, we recommend an emphasis on existing strategies for screening and treatment that have been documented to reduce the risk of diabetes and cardiovascular disease in the general population. References 1 : Surveillance, Epidemiology and End Results (SEER): Stat Fact Sheets. Prostate Cancer2008; . 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Google Scholar Department of Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byMilne M, Roehrborn C and Gruntmanis U (2019) Androgen Deprivation Therapy for Prostate Cancer: Specialty Clinic Collaboration and the Electronic Medical Record Can Improve Bone Health MonitoringUrology Practice, VOL. 7, NO. 4, (294-298), Online publication date: 1-Jul-2020.Crawford E, Twardowski P, Concepcion R, Hafron J, Harris R, Moul J, Gordan L, Petrylak D, Atkinson S, Boldt-Houle D, Keane T, Higano C, Henderson R, Kader A, Hussain M and Shore N (2019) The Impact of Late Luteinizing Hormone-Releasing Hormone Agonist Dosing on Testosterone Suppression in Patients with Prostate Cancer: An Analysis of United States Clinical DataJournal of Urology, VOL. 203, NO. 4, (743-750), Online publication date: 1-Apr-2020.Smith M, Morton R, Barnette K, Sieber P, Malkowicz S, Rodriguez D, Hancock M and Steiner M (2018) Toremifene to Reduce Fracture Risk in Men Receiving Androgen Deprivation Therapy for Prostate CancerJournal of Urology, VOL. 189, NO. 1S, (S45-S50), Online publication date: 1-Jan-2013.Lawrentschuk N, Fernandes K, Bell D, Barkin J and Fleshner N (2011) Efficacy of a Second Line Luteinizing Hormone-Releasing Hormone Agonist After Advanced Prostate Cancer Biochemical RecurrenceJournal of Urology, VOL. 185, NO. 3, (848-854), Online publication date: 1-Mar-2011.Smith M, Klotz L, Persson B, Olesen T and Wilde A (2010) Cardiovascular Safety of Degarelix: Results From a 12-Month, Comparative, Randomized, Open Label, Parallel Group Phase III Trial in Patients With Prostate CancerJournal of Urology, VOL. 184, NO. 6, (2313-2319), Online publication date: 1-Dec-2010.Smith M, Morton R, Barnette K, Sieber P, Malkowicz S, Rodriguez D, Hancock M and Steiner M (2010) Toremifene to Reduce Fracture Risk in Men Receiving Androgen Deprivation Therapy for Prostate CancerJournal of Urology, VOL. 184, NO. 4, (1316-1321), Online publication date: 1-Oct-2010.Related articlesJournal of Urology10 Nov 2018Metabolic Complications of Androgen Deprivation Therapy for Prostate Cancer Volume 181Issue 5May 2009Page: 1998-2008 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordsobesitygonadotropin-releasing hormone agonistsprostatic neoplasmscardiovascular diseasesdiabetes mellitusMetricsAuthor Information Philip J. Saylor More articles by this author Matthew R. Smith Supported by a National Institutes of Health K24 Midcareer Investigator Award (5K24CA121990-02), and grants from the Prostate Cancer Foundation and Lance Armstrong Foundation. More articles by this author Expand All Advertisement PDF downloadLoading ...