Renal Impairment: A Major Adverse Event in Prostate Cancer Patients Treated With Androgen Deprivation Therapy

Abstract

Androgen deprivation therapy (ADT) is the major treatment for advanced prostate cancer (PCa). Although ADT has been shown to improve oncological outcomes against PCa, it can also induce various adverse events, such as loss of libido, gynecomastia, fatigue, hot flashes, anemia, obesity, insulin resistance, dyslipidemia, cardiovascular events, and acute kidney injury (AKI). ADT reduces testosterone levels; consequently, ADT may antagonize the vasodilatory effects of testosterone on renal blood vessels, which could negatively affect renal tubular function. However, the renal impairment due to ADT is transient; i.e., it improves after the discontinuation of ADT. The recovery of serum testosterone levels may contribute to the amelioration of renal impairment induced by ADT. Serum testosterone levels are probably implicated in these changes, but the mechanism has not been studied in detail. With regard to the preservation of renal function and the anti-cancer effect of PCa, intermittent ADT may be a useful treatment for PCa. This is a review of the recent reports on the mechanism, current status, and prevention of renal impairment induced by ADT; future prospects in this field are also discussed.