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ASCO Educational Book; 2009
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Prostate Cancer Survivorship: Metabolic Complications of Androgen Deprivation Therapy

Philip J. Saylor, MD, and Matthew R. Smith, MD, PhD

From the Massachusetts General Hospital Cancer Center, The Claire and John Bertucci Center for Genitourinary Cancers, Boston, MA

M. R. Smith is supported by an NIH K24 Midcareer Investigator Award (5K24CA121990-02) and by grants from the Prostate Cancer Foundation.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Matthew R. Smith, MD, PhD, Director of Research, Massachusetts General Hospital Cancer Center, The Claire and John Bertucci Center for Genitourinary Cancers, 55 Fruit St, Yawkey 7038, Boston, MA 02114; e-mail: smith.matthew{at}mgh.harvard.edu

Overview: More than one-third of the approximately two million prostate cancer survivors in the United States receive androgen deprivation therapy (ADT). ADT by either bilateral orchiectomies or treatment with a gonadotropin-releasing hormone (GnRH) agonist causes loss of libido, vasomotor flushing, anemia, and fatigue. ADT also accelerates bone loss, decreases muscle mass, increases fat mass, increases cholesterol and triglycerides, and decreases insulin sensitivity. Consistent with these adverse effects, ADT has been associated with greater incidence of fractures, diabetes, and coronary heart disease. This review summarizes recent observations about the adverse skeletal and metabolic effects of ADT, including osteoporosis, obesity, sarcopenia, hyperlipidemia, and insulin resistance. The review also provides our recommendations for the prevention of treatment-related fractures, diabetes, and coronary heart disease adapted from evidence-based guidelines established for the general population.