Toxicity of Androgen Deprivation Therapy in Hormone-Sensitive Prostate Cancer
Androgen deprivation therapy for prostate cancer is one of the most effective types of systemic therapies in solid tumor malignancies and represents one of the first examples of “targeted therapy.” However, we have become increasingly aware of the adverse
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Naveed H. Akhtar, Elan S. Diamond, Nicole Eiseler, and Scott T. Tagawa
Introduction The introduction of androgen deprivation therapy (ADT) for prostate cancer (PC) was a seminal event in oncology, as one of the first widely successful methods of systemic therapy and one of the first examples of “targeted therapy” [1]. These drugs have significantly prolonged the median survival of patients with high-risk, locally advanced, or metastatic PC. As patients taking ADT are living longer, they may experience a variety of previously underrecognized, but clinically important side effects include metabolic derangements such as hyperlipidemia and diabetes mellitus (DM), osteoporosis, anemia, gastrointestinal disturbances, and psychiatric disorders. They are also at an increased risk of cardiovascular death when compared to age-matched men not treated with ADT. The majority of these side effects are attributable to both the short- and long-term sequel of testosterone deficiency and withdrawal. Recognition and management of these toxicities N.H. Akhtar, B.S., M.D. (*) Division of Hematology and Medical Oncology, Weill Cornell Medical College, 525 E. 68th Street, Starr 341, New York, NY 10065, USA e-mail: [email protected] E.S. Diamond, M.D. Division of Hematology and Medical Oncology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 E. 68th Street, M-528, New York, NY 10021, USA e-mail: [email protected] N. Eiseler, M.D. Department of Internal Medicine, SUNY Downstate, 450 Clarkson Road, Brooklyn, NY 11203, USA e-mail: [email protected] S.T. Tagawa, M.D., M.S. Division of Hematology and Medical Oncology, Weill Cornell Medical College, 525 E. 68th Street, Box 403, New York, NY 10065, USA Department of Urology, New York Presbyterian Hospital – Weill Cornell Medical College, 525 East 68th Street, ST-221, New York, NY 10065, USA e-mail: [email protected] A. Tewari (ed.), Prostate Cancer: A Comprehensive Perspective, DOI 10.1007/978-1-4471-2864-9_75, © Springer-Verlag London 2013
is an essential to the care of patients undergoing ADT for PC. Below, we will review the adverse effects of this pharmacologic class and present an evidence-based approach to managing these effects.
Metabolic Syndrome The metabolic syndrome (TMS) is a systemic disease characterized by a constellation of laboratory and physiologic abnormalities. The American Heart Association/National Heart, Lung, and Blood Institute recently published revised criteria for the diagnosis of TMS [2]. Three of five of the following criteria must be met to make the diagnosis in men: waist circumference of 40 or more inches, a triglyceride level of 150 mg/dl or more, high-density lipoprotein (HDL) cholesterol of 40 mg/dl or less, blood pressure greater than 130 mmHg systolic or greater than 85 mmHg diastolic, and an elevated fasting glucose of 100 mg/dl or more. A variety of other diagnostic schemas share similar criteria. The metabolic syndrome is an important risk factor for the development of DM and cardiovascular disease (CVD). Further
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