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Article: Complications of Androgen Deprivation Therapy in Men With Prostate Cancer

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Posted 10/3/2018 2:56 PM (GMT 0)
Here's a link to the full text version of an interesting article. We often discuss ADT and its side effects. The setting here is in metastatic disease, but the ADT effects are similar even for those of us using it as part of primary treatment for high risk cases.

Complications of Androgen Deprivation Therapy in Men With Prostate Cancer

In short, there are lots of side effects!

From the article:
Abstract / Synopsis:
The standard treatment for men with metastatic prostate cancer is androgen deprivation therapy (ADT). This therapy is associated with a multitude of side effects that can impact quality of life. These include vasomotor complications (in particular, hot flushes), sexual dysfunction and gynecomastia, osteoporosis, metabolic syndrome, and depression. Additionally, ADT has been associated with neurocognitive deficits, thromboembolic disease, and cardiovascular disease, although the data regarding the latter associations are mixed. This article summarizes the key side effects associated with ADT and discusses strategies to optimize management.
Posted 10/3/2018 3:47 PM (GMT 0)
Thanks, Redwing. Hope all's well with you.

My guy is back on Lupron since late August, 2018. There seem to be fewer side effects at the moment, which makes me wonder if it's doing the job. He'll go on Zytiga and Prednisone in November.
Posted 10/3/2018 4:11 PM (GMT 0)
Interesting stuff.

Thanks,
Andrew
Posted 10/3/2018 4:19 PM (GMT 0)
My MO is not impressed with whatever evidence may point to cardiovascular issues and he doesn’t believe it’s a problem.
Posted 10/3/2018 5:44 PM (GMT 0)
spouse21 - isn't it kind of funny we can think of bad side effects as good news? I did the same thing, considering my hot flashes as an ongoing reminder that the Lupron was properly suppressing my testosterone. I've been off of it now for just over 2-1/2 years, and feel quite well.

The cardiovascular effects have been somewhat contentious. It's hard to say, considering the guys receiving ADT tend to be old enough to be at risk for cardiovascular problems anyway.

It's also been a little unclear if the side effects are dominated merely by the lack of testosterone, or is there some independent effect from the drugs themselves. The study didn't talk about orchiectomy cases, since they're less common today even for permanent ADT (common with metastatic cases). Intermittent ADT is attractive though. One thing that got me through my ADT was knowing that it would end at some point! That hope alone may be worth doing intermittent ADT even though one may be metastatic.

On the other hand, if my case solidly recurs, I'm planning on the surgical route. It'll be earlier rather than later, and permanent, due to my 5+4 and cT3a situation; intermittent ADT is not generally considered a good option for cases like that specifically.
Posted 10/3/2018 6:05 PM (GMT 0)
Jerry, thanks for brightening my day. wink

I didnt click the link, but from your quote, got the gist of it, sounds like stuff we've already known about.

I am 6 weeks out from my first shot, 5 days out from my second, so far the only side effects I've had have been poor erectile function, and hot flushes, accompanied by sweats, but nothing troubling, just annoying.
But its early. I am guessing that alot of the SE's mentioned are more prominent among men on Long Term ADT.
Good luck to everyone who is on it LT.
As for me, i am going to just assume that i will be one of the lucky ones and get off easy, until proven otherwise, at which time i will just deal with it. i think thats all any of us can do once the choice is made.
Posted 10/3/2018 6:32 PM (GMT 0)
I'm finding the following book useful:
Androgen Deprivation Therapy: An Essential Guide for Prostate Cancer Patients and Their Loved Ones
2nd edition, 2018
by Wassersug, et. al.

It tries to give some impression on how often a side effect occurs, in which type of men, how long it lasts, how often it is bothersome, how to deal with it, etc. I find the long list of side effects (for any drug) to be scary without some qualification. Has anyone read this book or others?
Posted 10/3/2018 8:56 PM (GMT 0)
Yeah, it's weird to worry that fewer Lupron side effects the second time around might mean it isn't working. There's still time for the misery to kick in. My husband'll find out next month when he gets his PSA tested whether the ADT is doing something. His urologist said recently he thought it would knock the PSA down for a period since my husband had a "good" response for his former 31 months. Intermittent isn't on the table due to the fast doubling time. As his oncologist said when we asked about it: "You already had intermittent for nearly a year when you went off Lupron. The intermittent time is up." Yep.

Jerry, I'm glad you're enjoying decent health after your Lupron slog. I remember your oncologist made you go the 3-year distance. I still follow your case since it was like my husband's at dx but, of course, not now. confused
Posted 10/3/2018 9:42 PM (GMT 0)
The only reason ADT is accepted as a therapy at all is because it works so well and if it's refused, the side-effects that occur in short order are far, far, worse...
Posted 10/4/2018 1:22 AM (GMT 0)
It amazes me that medical folks can publish the same (old) info many times over:

Abstract / Synopsis:
The standard treatment for men with metastatic prostate cancer is androgen deprivation therapy (ADT). This therapy is associated with a multitude of side effects that can impact quality of life. These include vasomotor complications (in particular, hot flushes), sexual dysfunction and gynecomastia, osteoporosis, metabolic syndrome, and depression. Additionally, ADT has been associated with neurocognitive deficits, thromboembolic disease, and cardiovascular disease, although the data regarding the latter associations are mixed. This article summarizes the key side effects associated with ADT and discusses strategies to optimize management.
Posted 10/4/2018 1:34 AM (GMT 0)
Nothing really new here. 45 footnotes and only 2 from 2018. Exercise, eat healthy including ice cream and you can counter or lessen many of the side effects. Carry on.
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