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Review |
From the Division of Endocrinology and Metabolism and the Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| Correspondence to: Dr Shehzad Basaria, Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Suite 4300, Baltimore, MD 21224 (e-mail: sbasari1{at}jhmi.edu). |
Prostate cancer (PCa) is the most common cancer in men. Androgen
deprivation therapy (ADT) is used in the treatment of locally advanced and
metastatic PCa. Although its use as an adjuvant therapy has resulted in
improved survival in some patients, ADT has negative consequences.
Complications like osteoporosis, sexual dysfunction, gynecomastia, and adverse
body composition are well known. Recent studies have also found metabolic
complications in these men. Studies show that short-term ADT (3–6
months) results in development of hyperinsulinemia without causing
hyperglycemia. Studies of men undergoing long-term (
12 months) ADT reveal
higher prevalence of diabetes and metabolic syndrome compared with controls.
In addition, men undergoing ADT also experience higher cardiovascular
mortality. Long-term prospective studies of ADT are needed to determine the
timing of onset of these complications and to employ strategies to prevent
them. In the meantime, baseline and serial screening for fasting glucose and
other cardiac risk factors in men receiving ADT is prudent. In selected cases,
glucose tolerance testing and cardiac evaluation may be required.
Key words: Prostate, androgen deprivation, cardiovascular mortality, insulin resistance, metabolic syndrome
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