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Prostate Cancer Issues
Ernest H. Rosenbaum, MD

Androgen-deprivation therapy (ADT) has been one of the standards of treatment for many years. The use of LHRH (leutinizing hormone-releasing hormone) agonists have been one of the backbones of ADT therapy for locally advanced prostate cancer or asymptomatic and symptomatic metastatic patients. ADT treatment is frequently continued indefinitely, and often, in symptomatic patients, there is a survival of about two years. This is also regularly used for minimal disease, where the prostate specific antigen (PSA) is elevated and is often used for many years and sometimes decades.1

There is toxicity from the use of ADT, and programs with intermittent androgen blockade have also been used. Some of the side effects include:
1. Loss of libido, sexual dysfunction.

2. Hot flashes (shortly after starting ADT therapy).

3. Gynecomastia (enlarged breasts).

4. Decrease in lean body mass with increased body fat.

5. About 13% have depression or emotional debility and some cognitive dysfunction.

The hot flashes are often a severe problem, and Megastrol 20 mg b.i.d., diethylstilbestrol or estradiol patches have been of help. Cardiovascular problems and thrombophlebitis often become a problem, and a non-hormonal approach using ventafaxine and clonidine have also been tried.

There is also an increase in bone problems due to excretion of bone metabolites with occasional fractures. The use of calcium and vitamin D supplements with bisphosphonates is one of the solutions to help control this problem.

Additional problems include diabetes mellitus, hyperlipidemia (elevated blood cholesterol fats), hypertension (elevated blood pressure) and cardiovascular disease with increase in myocardial infarction (heart attack) and occasional sudden cardiac death.

Those treated with orchiectomy are at increased risk of diabetes but do not have the cardiovascular risks.

Those with many co-morbidities are more likely to have cardiovascular disease, as it is age related as well.

Thus, making lifestyle changes with diet and exercise, as well as calcium, vitamin D supplements and bisphosphonates, as indicated, can make a difference.

1. Roth, B. J., Hamilton, P. V., Howard, V. E., Journal of Supportive Oncology, "Managing the Side Effects of Androgen-Deprivation Therapy", vol. 5, 2, February, 2007, pg. 87-89.

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