Starting androgen deprivation therapy (ADT) to treat advanced prostate cancer is usually the start of a long treatment period that will continue for many years, actually until you die. Since our goal in cancer treatment is to make cancer a chronic illness and since prostate cancer does progress for most men in a relatively slow process it is time that we stop ignoring the sometimes horrendous side effects of ADT. The time has come for us to acknowledge these side effects and start to find ways to help mitigate them.
Currently, doctors acknowledge that these side effects exist, but they don’t do anything about them. The messages are clear, just deal with them, specifically deal with them on your own. Doctors do sometimes suggest that we exercise, using weight-bearing exercises and they do suggest that we modify our diet. But most hospitals and doctor practices do not help us accomplish these goals.
My first round of ADT brought about a weight gain of 50 pounds, when I asked my oncologist for nutrition help, specifically a referral to a nutritionist I was told that the Department did not have a nutritionist (this was Columbia University Hospital in New York City – really, no nutritionist at a major hospital center in their prostate cancer treatment department!).
Side effects of ADT should be anticipated, screened for and then mitigated. I don’t know how to do this, but it seems that we should be creating a multi-disciplinary team to deal with ADT side effects. This team should consist of an endocrinologist, a cardiologist, a geriatrician, a dietician, an exercise physiologist, and a psychologist. I know, I like to dream, but why not?
The concept of treating ADT side effects is not a foreign concept I am pulling out of my hat. A recent clinical trial by Cormie et al. is an example of successful exercise intervention in men starting ADT.