Hormone therapy for prostate cancer– side-effects and strategies

The authors aimed to determine the negative effects of hormone therapy and ways to avoid these effects in prostate cancer patients.

Androgen deprivation therapy (ADT) is a form of hormone therapy that targets the male sex hormones, such as testosterone, active in prostate cancer. Though it is a common and successful treatment option for prostate cancer patients, negative effects such as sexual dysfunction or events affecting the heart and bones are common side-effects.

The aim of this study was to determine the negative effects of ADT and ways of managing these effects in patients.

Patients who receive long-term ADT are more at risk of experiencing bone fractures and decreases in bone mineral density (BMD – used to determine patients risk of experiencing bone fractures and disease), with risks increasing by 5-10% after the first year of ADT treatment.

Methods used to reduce the risk of fractures and bone damage included zoledronic acid (Aclasta, Zometa) which increased bone strength by 5.6% when taken every 3 months for a year. Alendronate (Fosamax) reduced the occurrence of spinal damage and fractures by 1.7%. Denosumab (Prolia, Xgeva) improved bone strength by 5.6% after 2 years treatment and reduced the risk of fractures by 2.4% over 3 years compared to patients who were not taking denosumab.  Toremifene (Fareston) taken daily reduced 2-year bone fracture rate by 50% when compared to patients who were not on toremifene.

Patients who underwent ADT had an increased risk of developing diabetes, particularly patients who received treatment with hormonal drugs that activated a response in the body rather than preventing one. In some cases exercise was shown to reduce the risk of diabetes.

Patients who underwent ADT treatment  experienced more cardiovascular events and had an increased risk of heart attack, sudden cardiac death and and heart disease, particularly evident in patients with prior or existing heart conditions. In patients treated with degarelix (Firmagon) the number of events were higher where there was a previous or existing heart issue (10.5 events) compared to patients with no heart issue (5.3 events).

Sexual dysfunction is a known side-effect of ADT. The application of intermittent ADT treatment  increased sexual drive in patients without minimizing the effect of treatment in a group of patients who received 18 months of intermittent ADT and experienced an increased sexual desire compared to patients treated with continuous ADT for 36 months.

The authors conclude that ADT is a viable treatment in prostate cancer but numerous side-effects can occur that may affect the patients quality of life.

This was a compilation of numerous studies where research and treatment methods may have differed between each study, effecting the overall result.

If you are considering ADT as a treatment option, please consult your doctor on potential benefits and risks.