Different metabolic side effects across two forms of hormone therapy

This study compared early metabolic changes across different types of androgen deprivation therapy (ADT). Authors reported that some metabolic changes were more pronounced with pharmacological ADT compared to surgical ADT.

ADT is a type of hormone therapy commonly used to treat advanced prostate cancer. ADT targets the production of male hormones (such as testosterone) and reduces their effect on cancer cell growth. ADT can involve the surgical removal of the testicles (also called orchiectomy) or drug therapy (pharmacological ADT). Drug therapies either lower the production of testosterone in the body (GnRH agonists) or block the action of androgens (antiandrogens).

In some patients, ADT causes significant side effects. These can include brittle bones, sexual dysfunction, anemia (low levels of red blood cells), as well as metabolic syndrome. Metabolic syndrome can include a number of symptoms, including weight gain, high cholesterol levels, insulin resistance (the hormone needed to break down glucose), and diabetes. Metabolic syndrome can increase the risk of heart and blood vessel disease. Whether surgical ADT and pharmacological ADT are associated with different metabolic side effects has not been fully studied.

The aim of this study was to compare early metabolic changes across different types of ADT.

102 men with prostate cancer were included in the analysis. All men received first-time ADT. 46 men underwent surgical removal of both testicles. 56 men received drug therapy (with GnRH agonists). Approximately 19% of men in each group had a previous diagnosis of diabetes. Metabolic changes were assessed before and after 6 months of treatment.

Blood tests showed that testosterone levels and prostate growth levels were similar between surgical ADT and drug therapy. There were also no differences in basal metabolic rate (energy expenditure at rest), body mass index (a measure of body fat that takes weight and height into account), and fat composition. After 6 months of treatment, significant increases in cholesterol levels were noted in both ADT groups. However, these were not significantly different between groups.

Men receiving drug therapy showed greater insulin resistance compared to men receiving surgical ADT. This was more pronounced for diabetic men. Drug therapy also led to more severe anemia and brittle bones in the spine.

Authors concluded that pharmacological ADT induces certain metabolic side effects more than surgical ADT. 

Larger randomized trials examining long-term metabolic side effects are needed to confirm these preliminary results.