David P. Wood, Jr., MD gave a presentation at the 9th International Prostate Forum (IPF) on October 8 – 10, 2009 in Izmir, Turkey on the Management the side effects of hormone therapy (ADT) when used to treat of prostate cancer.
Dr. Wood indicated that the three major side effects of ADT in the treatment of prostate cancer are the loss of libido, erectile dysfunction, and the onset of metabolic syndrome. Each of these side effects alone can be debilitating and so it is important for the treating doctor to give significant consideration to minimizing these side effects.
He estimated that hot flashes occur in 80% of men who are on ADT and that they do not abate with time if not treated. He indicated that progestational agents are effective in minimizing hot flashes.
Metabolic syndrome includes lipid abnormalities that lead to weight gain, hypertension, coronary artery disease, and fatigue. Since these abnormalities are difficult to prevent, he strongly recommended early treatment with appropriate medication is critical. Additionally, he advocated an institution of an aggressive exercise program which can prevent or slow down the progress of the metabolic syndrome and fatigue.
Skeletal related events (SRE) are caused by osteoporosis and bone metastases. Osteoporosis is common in men on ADT and continues over time even if the treatment is stopped. SREs are associated with worse overall survival and so must be treated aggressively. The use of bisphosphonates such as zoledronic acid is effective in preventing SREs and may improve survival. Additionally, bisphosphonates are strongly recommended in men with widespread metastatic disease especially if they involve weight-bearing bones, and in symptomatic men. Bisphosphonates are not recommended for a rising PSA alone in men with CRPC.
Dr. Wood also pointed out that depression and cognitive loss is common in men on ADT. He felt that early treatment with anti-depressants is recommended (I do not agree with this blanket recommendation, antidepressants are not benign and so each man must first be carefully evaluated by a competent psychiatrist).
Dr. Wood also felt that intermittent ADT will prevent many of the reversible side effects, but he went on to recommend that intermittent treatment be withheld until the randomized SWOG study on continuous vs. intermittent ADT is published. Personally, I think the use of intermittent therapy be fully explained to each man so that all the potential risks and potential benefits are carefully explained and then allowing the individual man to make his own informed decision as to how his health-care is managed.
Joel T Nowak MA, MSW