ADT risks and side effects in advanced prostate cancer: cardiovascular and acute renal injury

Androgen deprivation therapy (ADT) is key to the treatment of men with advanced prostate cancer. ADT can consist of surgical (bilateral orchiectomy) or medical strategies (eg, luteinizing hormone-releasing hormone agonists or gonadotropin-releasing hormone [GnRH] antagonists). The substantial reduction of testosterone levels achieved with ADT is associated with numerous well-characterized side effects, the management of which are key to patients' quality of life. More recently, a group of metabolic changes (dyslipidemia, hyperglycemia, others) that carry an increased risk of diabetes and cardiovascular disease have been reported in men receiving ADT. We review recent evidence suggesting an increased risk of pneumonia, cardiovascular disease, and acute kidney injury in men treated with ADT and consider whether the incidence of such events differs with the treatment modality. We discuss possible mechanisms by which such events might be mediated, including the roles of testosterone and the GnRH receptor, and consider current guidelines in light of these data.