Androgen deprivation therapy (ADT) is frequently used for the treatment of advanced prostate cancer. ADT is associated with numerous side effects related to its mode of action, namely the suppression of testosterone to castrate levels.
Recently, several large retrospective studies have also reported an increased risk of diabetes and cardiovascular disease in men receiving ADT, although these risks have not been confirmed by prospective randomized trials. We review the literature to consider the risk of cardiovascular disease with different forms of ADT and examine in detail potential mechanisms by which any such risk could be mediated. Mechanisms discussed include the metabolic syndrome resulting from low testosterone level and the potential roles of testosterone flare, gonadotropin-releasing hormone receptors outside the pituitary gland, and altered levels of follicle-stimulating hormone. Finally, the clinical implications for men prescribed ADT for the treatment of advanced prostate cancer are considered.
Urologic oncology 2015 Jun 30 [Epub ahead of print]
Åsa Tivesten, Jehonathan H Pinthus, Noel Clarke, Wilhelmina Duivenvoorden, Jan Nilsson
Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Göteborg, Sweden Electronic address: asa tivesten@medic gu se , Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada , Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK , Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada , Department of Clinical Sciences, Lund University, Malmö, Sweden