Androgen-Deprivation Therapy for Prostate Cancer: Managing Cardiovascular Risks
Posted: Thursday, February 21, 2019
Dipti Gupta, MD, MPH, of Memorial Sloan Kettering Cancer Center, New York, and colleagues published a clinical review in the Journal of Oncology Practice addressing the adverse effects of androgen-deprivation therapy (ADT). The researchers advised medical professionals to engage in an individualized risk-benefit discussion and to develop a cohesive multidisciplinary management plan to closely monitor patients with prostate cancer before and during treatment with ADT.
Based on previous studies, ADT in patients with prostate cancer was found to be linked to a number of metabolic effects: a decrease in lean body mass and an increase in fat mass; an increase in total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels; as well as an increase in insulin resistance, fasting plasma glucose and glycosylated hemoglobin levels, insulin concentrations, incident diabetes mellitus in nondiabetic patients, and increased glycosylated hemoglobin levels in diabetic patients. It was also shown to cause a mimicker of metabolic syndrome in between 36% and 75% of patients.
Abiraterone and enzalutamide have demonstrated consistent association with hypertension. Several studies have demonstrated both short- and long-term ADT are associated with fatal and nonfatal cardiovascular disease events. In older patients, these comorbidities may increase the risk of non-cancer mortality.
Dr. Gupta and colleagues recommended that a comprehensive assessment of cardiovascular risk factors and lifestyle modification counseling be offered to all patients receiving ADT. Elements of this approach should include tobacco cessation, an exercise regimen, stress reduction, possible statin therapy for hyperlipidemia, aspirin for vascular health, metformin for diabetes, and angiotensin-converting enzyme inhibitors for hypertension. Additionally, patients should be made aware that they should seek immediate medical attention for new or worsening cardiovascular symptoms.
Disclosure: The study authors reported no conflicts of interest.