1. Symptoms & Sequelae of Chronic Androgen Deprivation Dr Charles Chabert

2. Background Huggins & Hodges in 1946 OrchidectomyOestrogen LHRH analogues

3. Sequelae of ADT 1.Hot flushes 2.Osteoporosis 3.Anaemia 4.Sexual dysfunction 5.Changes in BMI, metabolism & lipid profile 6.Cognitive impairment

4. Hot Flushes 80% on ADT Most bothersome Alteration in hypothalamic feedback

5. Hot Flushes- Treatment 1.Diethylstilbesterol 2.Megestrol Acetate 3.Cyproterone Acetate 4.Medroxyprogesterone Acetate

6. Osteoporosis Bone density reduction 2.5x increase in fracture Measurable changes after 9 months @ 1 year 3-5% bone mineral density Thrasher et al. Oncology 2004

7. Osteoporosis- Aetiology Testosterone mediates Osteoblastic proliferation Increase bone matrix formation Stimulates TGF-Beta & IGF-1 Testosterone conversion to Oestradiol Reduced oestradiol levels in ADT Thrasher et al. Oncology 2004

8. Osteoporosis- Prevention Intermittent ADT Cease smoking Moderate alcohol & caffeine Vit D & Ca supplements Weight bearing exercise Thrasher et al. Oncology 2004

9. Osteoporosis - treatment Bisphosphonates Inhibit osteoclast Zoledronic acid Thrasher et al. Oncology 2004

10. Anaemia Underlying cause of fatigue Normochromic, normocytic Reduced testosterone – reduced EPO 90% ADT have 10% reduction in HB 13% reduction >25% Strum et al BJU 1997; 79: 933

11. Sexual Dysfunction Occurs in most on ADT Reduced libido 2 nd to low testosterone Mechamism behind ED poorly understood Trial intermittent ADT or antiandrogen

12. Changes in BMI, Metabolism & Lipid Profile Median wt gain 6kg BMI increase 2.4% after 48 weeks 9% increase cholesterol 26.5% increase in serum triglycerides Smith et al J Clin Endo 2002; 87: 599

13. Cognitive Impairment Detrimental effect on memory, attention and verbal fluency Green et at BJU 2002; 90:427

14. Conclusion Council patients on ADT Lifestyle modifications Baseline Bone densiometry