Increased Risk of Metabolic Syndrome, Diabetes Mellitus, and Cardiovascular Disease in Men Receiving Androgen Deprivation Therapy for Prostate Cancer

• Published in: Pharmacotherapy Vol. 28; no. 12; pp. 1511 - 1522
• Main Authors: Kintzel, Polly E., Chase, Sandra L., Schultz, Lisa M., O'Rourke, Timothy J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-12-2008; Pharmacotherapy
• Subjects: ADT; Androgen Antagonists - adverse effects; Androgen Antagonists - therapeutic use; androgen deprivation therapy; Biological and medical sciences; CAD; cardiology; coronary artery disease; Coronary Artery Disease - chemically induced; diabetes; Diabetes Complications - chemically induced; Diabetes. Impaired glucose tolerance; Drug toxicity and drugs side effects treatment; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Humans; lipids; Male; Medical sciences; Metabolic diseases; metabolic syndrome; Metabolic Syndrome - chemically induced; Miscellaneous; Miscellaneous (drug allergy, mutagens, teratogens...); Nephrology. Urinary tract diseases; oncology; Other metabolic disorders; Pharmacology. Drug treatments; prostate cancer; Prostatic Neoplasms - drug therapy; Risk Assessment - methods; Risk Factors; Tumors of the urinary system; Urinary tract. Prostate gland; Endocrinopathy; Antineoplastic agent; coronary artery disease; Agonist; Decapeptide; Prostate disease; Peptides; Toxicity; Gonadotropin RH; Nonapeptide; Lipids; Male; Cardiovascular disease; Metabolic syndrome; oncology; ADT; Cancerology; Histrelin; Androgen deprivation; Adult; Male genital diseases; Hormone; Human; Leuprorelin; Urinary system disease; Androgen deprivation therapy; Diabetes mellitus; CAD; Metabolic diseases; Malignant tumor; Coronary heart disease; cardiology; Analog; Risk factor; Triptorelin; Prostate cancer; Goserelin; diabetes; Cancer
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.28.12.1511

Prostate cancer is the leading cancer diagnosis and second leading cause of cancer‐related mortality for men in the United States. Due to the increased prevalence of prostate cancer in men older than 50 years, men at risk for prostate cancer represent the same population of men who are at greatest risk for metabolic syndrome, diabetes mellitus, and coronary artery disease (CAD). In addition to risk factors for CAD that are applicable to the general population, men with prostate cancer can be at increased risk for CAD due to long‐term androgen deprivation therapy (ADT) administered as treatment for prostate cancer. Men undergo ADT by medical (drug therapy) or surgical (castration) means. Luteinizing hormone‐releasing hormone (LHRH) agonists are the primary drug therapies used for ADT. Commercially available LHRH agonists are goserelin, histrelin, leuprolide, and triptorelin. Body composition changes, hyperlipidemia, insulin resistance, metabolic syndrome, and acute coronary syndrome are all reported adverse effects of ADT, which are consequences of reduced levels of circulating testosterone. Metabolic and body composition changes associated with ADT arise within months of beginning medical ADT and persist after discontinuation of therapy. To better understand the increased risk of metabolic syndrome, diabetes, and heart disease in patients undergoing ADT for prostate cancer, we performed a MEDLINE search (1986–2008) to identify pertinent studies and reports. Additional citations were obtained from the articles retrieved from the literature search. We found that the increased risk for serious cardiovascular disease becomes evident within months of beginning ADT. Pharmacists should provide counseling to these patients on primary disease prevention. Men receiving ADT should be monitored routinely for signs and symptoms of metabolic syndrome, diabetes, and CAD. Healthy lifestyle practices should be encouraged, and physical therapy should be considered for these patients.