Annual General Practitioner Study Day 2012 Men’s Health Workshop Managing side effects of male cancer therapy Dr Conleth Murphy, Consultant Medical Oncologist

Prostate cancer therapies Endocrine therapies – ADT: Orchiectomy or LHRH analogues – Anti-androgens: bicalutamide (casodex) Chemotherapy – Docetaxel (Taxotere) – Cabazitaxel Novel therapies – Abiraterone (Zytiga)

Androgen Deprivation Therapy Cognitive dysfunction Worsening of diabetes Hot flashes Weight gain Erectile dysfunction Cardiovascular effects Loss of libido Osteoporosis Anaemia Sarcopaenia

Side effects of ADT Hot flashes – Acupuncture 1, venlafaxine 2, medroxyprogesterone acetate 2 (20mg/day), cyproterone 2 (androcur), gabapentin. Anaemia – Monitor B12, folate, TIBC. Avoid EPO Metabolic syndrome and cardiovascular health – 50% of men on long term ADT have metabolic syndrome. – Monitor BP, lipids and glucose. – Encourage diet and resistance exercise. – Cardiology review for men with pre-existing IHD 1.Frisk J, Spetz AC, Hjertberg H, Petersson B, Hammar M. Two modes of acupuncture as a treatment for hot flashes in men with prostate cancer—a prospective multicenter study with long-term follow-up. European Urology. 2009;55(1):156–163 2.Irani J, Salomon L, Oba R et al. Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial, The Lancet Oncology, Volume 11, Issue 2, February 2010, Pages

Osteoporosis Osteoporosis is common – ~35% of hormone-naïve men with prostate CA – ~80% after 10 years of ADT Baseline DEXA Repeat at least every 2 years Weight bearing and resistance exercise Calcium 1200mg + Vit D 800 u daily Zoledronic acid 4mg IV yearly Alendronate 70mg weekly orally Denosumab 60mg S/C q6/12 reduced fracture risk.

Chemotherapy Up to 10 cycles of docetaxel – Febrile neutropaenia: reduced with neulasta – Nail changes: cold gloves can help – Neuropathy: dose reduction, pregabalin – Watery eyes: lubricants, steroid eyedrops, intervention for canal stenosis – Anaemia: correct deficiencies, consider EPO Steroids reduce fluid retention Please call with any concerns Continue LHRH analogue throughout Rx Cabazitaxel: similar but high rates diarrhoea and neutropaenia

Abiraterone Novel oral inhibitor of androgen synthesis – Improves survival c/w best supportive care – 4x 250mg tablets daily 2 hrs after food – Prednisolone 10mg daily Oedema Hypertension Abnormal LFTs Hypokalaemia – Check BP, LFTs, U&E every 2 weeks for 3 months