Side effects of androgen deprivation therapy: monitoring and minimizing toxicity

In 2003, concerns were raised about the long-term side effects of androgen deprivation therapy (ADT) used for nonmetastatic prostate cancer, particularly at the stage of biochemical recurrence or rising prostate-specific antigen (PSA) levels. Sexual side effects such as loss of libido, erectile dysfunction (ED), and hot flashes were the most recognized, with hot flashes affecting close to 80% of patients. Treatments for hot flashes included estrogens, progestin megestrol acetate, medroxyprogesterone acetate, venlafaxine, and cyproterone acetate. Less commonly acknowledged were physiological effects like gynecomastia, changes in body composition, lipid alterations, which could exacerbate conditions like hypertension, diabetes, and coronary artery disease. Other side effects included loss of bone mineral density, anemia, hair changes, and psychological distress. The paper highlighted the need for more systematic clinical trials to study these side effects and called for physicians to integrate prevention and management of ADT toxicities into routine care.