Androgen deprivation therapy of prostate cancer and cardiovascular morbidity

Abstract

Androgen deprivation therapy (ADT) of prostate cancer (PC) is burdened by a number of adverse events or effects (AEs). Immediate AEs are hot flashes and sweating, the main AE of long-term ADT include body feminisation, sexual and cognitive changes, fatigue or sleep disturbances. Other AEs are related to metabolic changes (osteoporosis, changes in lipid metabolism, insulin resistance and metabolic syndrome). Serious AEs include fractures and cardiovascular events (CVEs). Treatment with agonists of luteinizing hormone-releasing hormone (LHRH) is associated with a higher risk of CVEs compared to the LHRH antagonist degarelix. Higher rate of CVEs during therapy with LHRH agonists is most likely caused by a higher level of follicle stimulating hormone (FSH) which leads to a greater instability of atherosclerotic plaque. Randomized trials that will assess the effect of LHRH agonists and degarelix on the risk of CVEs are still active without the results available so far. Preventive measures during ADT for PC should target loss of weight, increased exercise, improved nutrition and smoking cessation.