Adverse Effects Of Androgen Deprivation Therapy (ADT)

Gonadotrophin- releasing-hormone (GnRH) agonist is the most commonly prescribed androgen deprivation therapy (ADT) that is used for the management of metastatic varieties of prostate cancer. These hormonal analogues are administered via injections or implants under the skin. The key mechanism of action is to inhibit the formation of testosterone by restricting the pituitary gland from releasing hormones (that in turn acts on testes to secrete testosterone).

What Are Some Side Effects Associated With ADT?

Before going for androgen deprivation therapy, you must know the associated risks and side effects of the therapy. The possible sexual side effects include:

• Loss of libido (sexual drive)
• Difficulty in achieving and keeping the erection for longer periods of time

These common sexual side effects can also occur with other treatment options like surgery and radiotherapy. Besides sexual problems other side effects include:

• Tiredness, sweating, hot flushes osteoporosis, decrease in body hair, reduction in muscle strength.
• Cognitive issues like memory problem and difficulty in doing multiple tasks at a time can also occur.
• According to a new study reported in the Journal of Clinical Oncology (3), investigators sugg

• ested that men who are on ADT therapy are more likely to develop cardiovascular dysfunction (myocardial ischemia, sudden cardiac death etc.) and type 2 diabetes (due to insulin resistance and negative changes in fat metabolism).
• When taking tablet form of ADT, side effects such as problem in liver functioning, development of breasts and sore nipples are also observed.
• Lower bone mineral density (BMD) i.e. thinning of bone and osteoporosis are the possible bone related problems that are reported in patients on ADT. These metabolic changes aggravates the risk of hip and spine fractures. Bone related side effects are observed within a few months of initiating the therapy and symptoms usually worsen if the therapy is continued for several years.

How To Manage Side Effects Associated With ADT?

• Tiredness, and cognitive changes can be overcome by maintaining a healthy diet and exercise on regular basis.
• Hot flushes can be controlled with medicines while sexual issues can be treated with specific treatments that are designed according to your sexual needs.
• Muscles and bone strength can be improved with exercises like jogging, walking, climbing stairs or weight training exercise.

How To Prevent Side Effects Associated With ADT?

Risk of developing complications and health problems can be reduced by adopting some healthy lifestyle changes, such as:

• Before starting ADT, it is highly recommended to check with your doctor if you are at risk of developing bone or liver related problems such as osteoporosis, liver dysfunction and bone fractures.
• In addition, make sure to opt for a pre- treatment bone scan to assess your bone-mineral density status.
• While on therapy, make sure to see your doctor at regular intervals for early detection and prompt management of common complications.
• Men who are at high risk of developing complications (such as poor liver health, low muscle mass or poor bone mineral density) should opt for comprehensive yearly or bi-annual examinations.
• Avoid smoking and high consumption of alcohol while on androgen deprivation therapy.
• Increase your intake of calcium rich diets and calcium supplements.
• If required, intake of vitamin D supplements should be initiated.
• Targeted treatments for men with history of bone fractures or men with low mineral bone density also helps in reducing the risk of bone damage while on ADT.

References

1. Basaria, S., Lieb, J., Tang, A. M., DeWeese, T., Carducci, M., Eisenberger, M., & Dobs, A. S. (2002). Long‐term effects of androgen deprivation therapy in prostate cancer patients. Clinical endocrinology, 56(6), 779-786.

2. Braga-Basaria, M., Dobs, A. S., Muller, D. C., Carducci, M. A., John, M., Egan, J., & Basaria, S. (2006). Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy. Journal of Clinical Oncology, 24(24), 3979-3983.

3. Keating, N. L., O'Malley, A. J., & Smith, M. R. (2006). Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology, 24(27), 4448-4456.

4. Smith, M. R., Eastham, J., Gleason, D. M., Shasha, D., Tchekmedyian, S., & Zinner, N. (2003). Randomized controlled trial of zoledronic acid to prevent bone loss in men receiving androgen deprivation therapy for nonmetastatic prostate cancer. The Journal of urology, 169(6), 2008-2012.