Androgen deprivation therapy complications

被引:38
作者
Allan, Carolyn A. [1 ,2 ,3 ,4 ]
Collins, Veronica R. [2 ]
Frydenberg, Mark [5 ,6 ]
McLachlan, Robert I. [1 ,2 ,3 ,4 ]
Matthiesson, Kati L. [1 ,7 ]
机构
[1] MIMR PHI Inst Med Res, Clayton, Vic 3168, Australia
[2] Monash Univ, Sch Publ Hlth & Prevent Med, Androl Australia, Prahran, Vic, Australia
[3] Monash Hlth, Dept Endocrinol, Melbourne, Vic, Australia
[4] Monash Univ, Dept Obstet & Gynaecol, Clayton, Vic 3168, Australia
[5] Monash Univ, Dept Surg, Clayton, Vic 3168, Australia
[6] Monash Hlth, Dept Urol, Melbourne, Vic, Australia
[7] Monash Hlth, Program Med, Melbourne, Vic, Australia
关键词
prostate cancer; androgen deprivation therapy; quality of life; bone; osteoporosis; fracture; cardiovascular disease; diabetes; QUALITY-OF-LIFE; ADVANCED PROSTATE-CANCER; BODY-COMPOSITION CHANGES; PREVENT BONE LOSS; CARDIOVASCULAR-DISEASE; ARTERIAL STIFFNESS; INSULIN-RESISTANCE; COGNITIVE FUNCTION; HORMONAL-THERAPY; HOT FLASHES;
D O I
10.1530/ERC-13-0467
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Androgen deprivation therapy (ADT) is increasingly used to treat advanced prostate cancer and is also utilised as adjuvant or neo-adjuvant treatment for high-risk disease. The resulting suppression of endogenous testosterone production has deleterious effects on quality of life, including hot flushes, reduced mood and cognition and diminished sexual function. Cross-sectional and longitudinal studies show that ADT has adverse bone and cardio-metabolic effects. The rate of bone loss is accelerated, increasing the risk of osteoporosis and subsequent fracture. Fat mass is increased and lean mass reduced, and adverse effects on lipid levels and insulin resistance are observed, the latter increasing the risk of developing type 2 diabetes. ADT also appears to increase the risk of incident cardiovascular events, although whether it increases cardiovascular mortality is not certain from the observational evidence published to date. Until high-quality evidence is available to guide management, it is reasonable to consider men undergoing ADT to be at a higher risk of psychosexual dysfunction, osteoporotic fracture, diabetes and cardiovascular disease, especially when treated for extended periods of time and therefore subjected to profound and prolonged hypoandrogenism. Health professionals caring for men undergoing treatment for prostate cancer should be aware of the potential risks of ADT and ensure appropriate monitoring and clinical management.
引用
收藏
页码:T119 / T129
页数:11
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