Prostate cancer is the most common cancer in men, with approximately 2 million survivors in the United States. According to the American Cancer Society’s Cancer Facts & Figures, 248,530 men were expected to be diagnosed in 2021 — including 3,160 in Connecticut.
For many men, a prostate cancer diagnosis does not alter life expectancy, with the five-year relative survival for all stages at 98.8 percent. Even for men with metastatic prostate cancer — cancer that has spread from the prostate to other parts of the body, such as bones, lymph nodes or other organs — median survival has increased with 10-year survival approaching 10 percent. So with improvements in survival, consideration of the side effects of androgen deprivation therapy (ADT) in the 30 percent of U.S. prostate cancer survivors on active treatment is essential in optimizing health and quality of life.
ADT, the mainstay of cancer therapy for advanced prostate cancer, lowers androgen levels to reduce stimulation of prostate cancer cell growth. This may be accomplished by either bilateral orchiectomy (removal of both testicles) or by medications known as gonadotropin-releasing hormone (GnRH) agonists (such as Lupron and Eligard). These medications are quite effective in reducing androgen levels (testosterone) leading to severe hypogonadism — reduction or absence of hormone secretion of the gonads (testicles).
ADT’s primary side effects are related to this significant androgen deficiency: vasomotor flushing (“hot flashes”), loss of libido/sexual dysfunction, osteoporosis (thinning of the bones), increased fat mass, decreased skeletal muscle mass, increased risk of diabetes and cardiovascular disease.
Additional side effects may include fatigue, anemia (low red blood cells), body image changes (gynecomastia, or breast tissue enlargement), thinning of hair and a possible decrease in size of testicles and/or the penis. Emotional and mental processing changes also may be noticed.
Maintaining good overall health and limiting adverse effects of ADT should be a priority. When initiating treatment, consider a baseline bone density evaluation with a DEXA scan (dual-energy x-ray absorptiometry), in addition to working with your primary care physician and/or cardiologist to optimize cardiovascular health with a focus on cholesterol, monitoring fasting lipoproteins and blood pressure control. A screening with fasting plasma glucose for prediabetes may be included.
Although your physicians may prescribe medications to help treat side effects, lifestyle modification is an essential approach to addressing side effects. For example, regular exercise has been shown to reduce fatigue, improve muscle mass and strength and cardiac fitness. There is also some weaker evidence to suggest that it may lessen bone loss and reduce the risk of fractures, as well as improving sexual function and mental health.
Guideline recommendations for physical activity include 150 minutes per week of aerobic exercise, exercising a minimum of five days per week. Resistance training and weight-bearing exercises may further help bone health. Besides taking supplemental vitamin D (800-1000 IU/day) and ensuring a dietary intake of 1200 mg/day of calcium, men on ADT should moderate alcohol intake and stop smoking.
At the Hartford HealthCare Cancer Institute, a multidisciplinary approach to patient care recognizes that the side effects of ADT therapy for prostate cancer can be significant.
We have partnerships with:
- Endocrinologists to address bone health.
- Cardio-oncology specialists who focus on the cardiovascular health of patients undergoing cancer therapy.
- Integrative medicine for alternative methods to address hot flashes and assist with lifestyle modification.
- Psychology and social workers to assist patients and their partners with coping in the setting of emotional impacts of a cancer diagnosis and its related side effects.
- Nutritionists and physical therapists to counsel regarding lifestyle modification.
- Urologists to address sexual dysfunction.
Clinical research opportunities also may be available to explore alternative therapies to mitigate side effects.
Reporting any and all symptoms to your physicians and care team members is an essential part of the cancer journey so that a holistic approach may be taken to not only treat your prostate cancer, but to also optimize overall health and quality of life.
Dr. Jessica M. Clement, a genitourinary medical oncologist, is Medical Director of Oncology Research and Medical Director of Phase I Program at the Hartford HealthCare Cancer Institute.