Androgen deprivation therapy for prostate cancer: new concepts and concerns

Smith, Matthew R.

doi:10.1097/med.0b013e32814db88c

Cited by 147 publications

(132 citation statements)

References 94 publications

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“…Since such men have excellent rates of cancer-specific survival (up to 90%), the benefits of ADT need to be carefully balanced against the toxicities, which are a direct consequence of the induced hypogonadism. 1 Adverse effects of ADT include firstly, loss of bone mineral density leading to fractures; secondly, weight gain, insulin resistance and diabetes; [5][6][7] thirdly, sexual symptoms such as sexual dysfunction, gynecomastia, decrease in testicular and penile size, loss of sexual hair; and, fourthly, general and constitutional symptoms including neurophysiological symptoms (reduced mood cognition, quality of life (QoL)), hot flushes, fatigue and anemia. 1,8 Given that prostate cancer is a disease predominantly of ageing men, age itself and associated comorbidities may contribute to increased vulnerability of the hemopoietic system to ADT, although this assumption has not been formally tested in clinical studies.…”

Section: Introductionmentioning

confidence: 99%

Hematological changes during androgen deprivation therapy

Grossmann¹,

Zajac²

2012

Asian J Androl

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Androgen deprivation therapy (ADT) has been associated with a plethora of adverse effects, consistent with the androgen dependency of multiple reproductive and somatic tissues. One such tissue is the hemopoietic system, and one of the most predictable consequences of ADT is the development of anemia. Although anemia caused by ADT is rarely severe, ADT is often given to frail, elderly men with increased susceptibility to anemia due to multiple other causes. ADT-associated anemia may contribute to fatigue and reduced quality of life (QoL) in such men, although this requires further study. While anemia is an independent risk factor of mortality in men with prostate cancer, it is not known whether treatment of ADT-associated anemia alters clinically important outcomes, or whether treatment affects mortality. Awareness of the phenomenon of ADT-induced anemia should avoid unnecessary work-up in mild cases of normocytic normochromic anemia. However, assessment and treatment of more severe anemia may be required. This should be determined on an individual basis. In contrast to the well-described actions of ADT on erythropoiesis, its effect on other hemopoietic lineages has been less well elucidated. While preclinical studies have found roles for androgens in maturation and differentiated function of neutrophils, lymphocytes and platelets, the implications of these findings for men with prostate cancer receiving ADT require further studies.

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Section: Introductionmentioning

confidence: 99%

Hematological changes during androgen deprivation therapy

Grossmann¹,

Zajac²

2012

Asian J Androl

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“…3,4 Over 600 000 men with PCa in the United States are treated annually with ADT. 5 Osteoporosis is a serious complication of long-term ADT. 6 Bisphosphonates are agents that inhibit proliferation and differentiation of osteoclasts and repress bone resorption by osteoclasts, and have already been used for treatment of primary osteoporosis.…”

Section: Introductionmentioning

confidence: 99%

Risedronate prevents persistent bone loss in prostate cancer patients treated with androgen deprivation therapy: results of a 2-year follow-up study

Izumi

Mizokami

Sugimoto

et al. 2011

Prostate Cancer Prostatic Dis

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Androgen deprivation therapy (ADT) for prostate cancer (PCa) causes bone loss. Although we reported previously that risedronate significantly recovers bone mineral density (BMD) for up to 12 months, there have been no reports with longer follow-up periods to date. This study extended our earlier series extending the follow-up period to 24 months. Eligible patients had histologically confirmed PCa without lumbar spine metastasis and underwent ADT. Lumbar spine BMD, urinary deoxypyridinoline (uDPD) and serum bone alkaline phosphatase were measured at 6, 12 and 24 months. Among the total of 96 patients, we analyzed 26 and 18 patients in risedronate administration and control groups, respectively. BMD relative to the young adult mean ratio, uDPD and serum bone alkaline phosphatase of the risedronate administration group recovered significantly after 24 months compared with the control group (Po0.0001, P ¼ 0.0001, and Po0.0001, respectively). Transient blurred vision, malaise and vertigo were observed in 1 patient each among the 46 patients treated with risedronate within 28 days after first administration. Oral administration of risedronate is safe and effective for the recovery of ADT-induced bone loss in PCa patients even at 24 months after commencement of treatment.

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“…Several agents are known to have a positive effect on BMD in the extreme event of acute hypogonadism due to chemical castration, including bisphosphonates and denosumab (discussed below) [83,84]. It seems reasonable to use these agents to avoid bone loss in men receiving androgen deprivation therapy, particularly when baseline BMD is low or if other fracture risk factors are present.…”

Section: Sex Hormonesmentioning

confidence: 99%

Treatment of osteoporosis in men

Ringe

2007

The Journal of Men's Health & Gender

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Summary: Aspects of osteoporosis in men, such as screening and identification strategies, definitions of diagnosis and intervention thresholds, and treatment options (both approved and in the pipeline) are discussed. Introduction: Awareness of osteoporosis in men is improving, although it remains under-diagnosed and under-treated. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) workshop was convened to discuss osteoporosis in men and to provide a report by a panel of experts (the authors). Methods: A debate with an expert panel on preselected topics was conducted. Results and conclusions: Although additional fracture data are needed to endorse the clinical care of osteoporosis in men, consensus views were reached on diagnostic criteria and intervention thresholds. Empirical data in men display similarities with data acquired in women, despite pathophysiological differences, which may not be clinically relevant. Men should receive treatment at a similar 10-year fracture probability as in women. The design of mixed studies may reduce the lag between comparable treatments for osteoporosis in women becoming available in men.

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Androgen deprivation therapy for prostate cancer: new concepts and concerns

Cited by 147 publications

References 94 publications

Hematological changes during androgen deprivation therapy

Hematological changes during androgen deprivation therapy

Risedronate prevents persistent bone loss in prostate cancer patients treated with androgen deprivation therapy: results of a 2-year follow-up study

Treatment of osteoporosis in men

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