Androgen deprivation therapy for the treatment of prostate cancer: consider both benefits and risks

Isbarn, Hendrik; Boccon-Gibod, Laurent; Carroll, Peter R; Montorsi, Francesco; Schulman, Claude; Smith, Matthew R; Sternberg, Cora N; Studer, Urs E (2009). Androgen deprivation therapy for the treatment of prostate cancer: consider both benefits and risks. European urology, 55(1), pp. 62-75. Amsterdam: Elsevier 10.1016/j.eururo.2008.10.008

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CONTEXT: Androgen deprivation therapy (ADT) is increasingly used for the treatment of prostate cancer (PCa), even in clinical settings in which there is no evidence-based proof of prolonged overall survival (OS). ADT, however, may be associated with numerous side effects, including an increased therapy-related cardiovascular mortality. OBJECTIVE: To discuss different clinical settings in which ADT is currently used and to critically weigh the benefits of ADT against its possible side effects. EVIDENCE ACQUISITION: A MEDLINE search was conducted to identify original articles and review articles addressing the efficacy and side effects of ADT for the treatment of PCa. Keywords consisted of prostate cancer, hormonal therapy, adverse effects, radical prostatectomy, and radiotherapy. The articles with the highest level of evidence for the various examined end points were identified with the consensus of all authors and were reviewed. EVIDENCE SYNTHESIS: Even short-term use of ADT may lead to numerous side effects, such as osteoporosis, obesity, sarcopenia, lipid alterations, insulin resistance, and increased risk for diabetes and cardiovascular morbidity. Despite these side effects, ADT is commonly used in various clinical settings in which a clear effect on improved OS has not been shown. CONCLUSIONS: ADT is associated with an increased risk of multiple side effects that may reduce quality of life and/or OS. Consequently, these issues should be discussed in detail with patients and their families before initiation of ADT. ADT should be used with knowledge of its potential long-term side effects and with possible lifestyle interventions, especially in settings with the highest risk-benefit ratio, to alleviate comorbidities.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology

UniBE Contributor:

Studer, Urs

ISSN:

0302-2838

ISBN:

18945543

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:04

Last Modified:

06 Dec 2013 13:53

Publisher DOI:

10.1016/j.eururo.2008.10.008

PubMed ID:

18945543

Web of Science ID:

000262066700011

URI:

https://boris.unibe.ch/id/eprint/27981 (FactScience: 115384)

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