Complications of androgen deprivation therapy in prostate cancer

To review the current data on adverse effects of androgen deprivation therapy for prostate cancer and to discuss some considerations when choosing therapy and managing side-effects.

Despite the existing data supporting the use of androgen deprivation therapy in prostate cancer patients, several questions regarding timing, survival benefit and impact in quality of life remain quite controversial. Although androgen deprivation therapy appears to increase overall survival in select populations with locally advanced and symptomatic metastatic prostate cancer, their side-effects often lead to secondary short and long-term toxicities that negatively impact patient's quality of life and ultimately affect their survival. In addition to the most common side-effects of low testosterone levels such as hot flushes, lack of libido, erectile dysfunction, gynecomastia and bone mineral density loss, recent studies have confirmed the detrimental effects of low testosterone states on patient's cardiac risk profile and development of metabolic syndrome ultimately leading to an increase risk of diabetes, hyperlipidemia and heart disease.

Long-term use of androgen deprivation in prostate cancer patients continues to increase. Timing of therapy should be optimized based on each individual's prostate cancer natural history and medical risk profile. Emphasis should be placed on quality of life concerns, with adequate pretreatment education of anticipated side-effects, individualization of therapy, and review of strategies for prevention of side-effects.