Androgen deprivation therapy: indications, methods of utilization, side effects and their management

Our objective is to provide an up-to-date summary of current literature on the indications for androgen deprivation therapy (ADT), ways in which ADT is used, and the main side effects associated with its use. MEDLINE (Pubmed) was searched for relevant papers published from database inception to May 1, 2019 for studies evaluating the use of ADT and its associated adverse events. ADT is a mainstay in the treatment of prostate cancer and is used throughout the disease course. While predominantly used in the metastatic setting, ADT has a role in the treatment of localized disease and in the management of recurrent cancer. Intermittent ADT has an application for a certain subset of men with recurrent and metastatic disease who have significant side effects. Associated side effects of ADT are wide ranging and include osteoporosis with an associated increased fracture risk, elevated rates of diabetes, metabolic syndrome, cardiovascular risk, sexual dysfunction and hot flashes. As ADT has a variety of associated side effects, care for men receiving ADT is best managed in a multidisciplinary setting with active participation between the treating physician (urologist, radiation oncologist) and their primary care physician.