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Symptoms & Sequelae of Chronic Androgen Deprivation Dr Charles Chabert
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Background Huggins & Hodges in 1946 OrchidectomyOestrogen LHRH analogues
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Sequelae of ADT 1.Hot flushes 2.Osteoporosis 3.Anaemia 4.Sexual dysfunction 5.Changes in BMI, metabolism & lipid profile 6.Cognitive impairment
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Hot Flushes 80% on ADT Most bothersome Alteration in hypothalamic feedback
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Hot Flushes- Treatment 1.Diethylstilbesterol 2.Megestrol Acetate 3.Cyproterone Acetate 4.Medroxyprogesterone Acetate
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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
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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
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Osteoporosis- Prevention Intermittent ADT Cease smoking Moderate alcohol & caffeine Vit D & Ca supplements Weight bearing exercise Thrasher et al. Oncology 2004
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Osteoporosis - treatment Bisphosphonates Inhibit osteoclast Zoledronic acid Thrasher et al. Oncology 2004
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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
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Sexual Dysfunction Occurs in most on ADT Reduced libido 2 nd to low testosterone Mechamism behind ED poorly understood Trial intermittent ADT or antiandrogen
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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
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Cognitive Impairment Detrimental effect on memory, attention and verbal fluency Green et at BJU 2002; 90:427
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Conclusion Council patients on ADT Lifestyle modifications Baseline Bone densiometry
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