Androgen deprivation therapy in prostate cancer: focusing on sexual side effects

Androgen deprivation therapy (ADT) is the cornerstone in the treatment of advanced and metastatic prostate cancer (PC). However, recent publications suggest that ADT may increase cardiovascular (CV) problems (morbidity and mortality), most probably because androgens regulate fat distribution, insulin sensitivity, and lipid metabolism.

The aim of the present review is to analyze different modalities of ADT, emphasizing advantages and possible related adverse sexual events.

A systematic search of published evidence was performed using Medline (from 1969 to September 2011).

The most important studies regarding the relationship among testosterone, PC, and the role of ADT were reviewed.

There is unequivocal evidence that reducing androgen signaling to the hypogonadal range can reduce PC growth and patient symptoms; however, androgen dependency of prostate growth is evident only in the hypogonadal condition but not in the eugonadal state (the "saturation hypothesis"). There is clear evidence that ADT improves disease-free and overall survival only under two conditions: (i) in combination with primary radiation for locally advanced or high-risk diseases and (ii) as an adjuvant therapy for positive lymph node diseases after prostatectomy. On the other hand, it should be recognized that ADT can adversely affect not only traditional CV risk factor (including serum lipoproteins, insulin sensitivity, and obesity) but also sexual life, being associated with reduced libido and erectile, ejaculatory, and orgasmic disorders.

Physicians should weigh the risk/benefit ratio before prescribing ADT.