Cardiovascular risk and bone loss in men undergoing androgen deprivation therapy for non‐metastatic prostate cancer: implementation of standardized management guidelines

• Published in: Andrology (Oxford) 2013-07, Vol.1 (4), p.583-589
• Main Authors: Cheung, A. S., Pattison, D., Bretherton, I., Hoermann, R., Lim Joon, D., Ho, E., Jenkins, T., Hamilton, E. J., Bate, K., Chan, I., Zajac, J. D., Grossmann, M.
• Format: Article
• Language: English
• Subjects: Aged; Androgen Antagonists - adverse effects; androgen deprivation; Antineoplastic Agents, Hormonal - adverse effects; Biological and medical sciences; Biomarkers - blood; Bone Density - drug effects; cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Comorbidity; Diseases of the osteoarticular system; Fundamental and applied biological sciences. Psychology; Guideline Adherence; Gynecology. Andrology. Obstetrics; Hospitals, Teaching; Humans; Male; Male genital diseases; Mammalian male genital system; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; osteoporosis; Osteoporosis - chemically induced; Osteoporosis - diagnostic imaging; Osteoporosis - epidemiology; Osteoporosis - prevention & control; Osteoporosis. Osteomalacia. Paget disease; Practice Guidelines as Topic; Prevalence; Prospective Studies; prostatic neoplasms; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Radiography; Risk Factors; Tertiary Care Centers; Time Factors; Treatment Outcome; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Vertebrates: reproduction; Victoria - epidemiology
• ISSN: 2047-2919; 2047-2927
• DOI: 10.1111/j.2047-2927.2013.00093.x

Summary Our objective was to evaluate the effectiveness of implementing standardized guidelines to mitigate metabolic and bone side effects of androgen deprivation therapy (ADT) in men with non‐metastatic prostate cancer. We conducted a 2‐year prospective cohort study at a tertiary referral teaching hospital. Overall, 236 men (mean age 69.8 ± 7.1) commencing ADT for non‐metastatic prostate cancer attended a baseline clinic visit between 2007 and 2011, and 153 men were eligible for follow‐up after 2 years of continuous ADT. Of these, 113 men had data available for analysis at 2 years. At baseline, 87% of the men were overweight or obese, 61% had hypertension, 56% had hypercholesterolaemia, 27% prior cardiovascular disease, 11% osteoporosis and 40% osteopaenia. After 2 years of ADT, there was an increase in waist circumference (+2.8 ± 6.3 cm, p = 0.002), and, in men without diabetes, in HbA1c (+0.13 ± 0.34%, p = 0.019). Despite this, due to treatment, there were significant reductions in total cholesterol (−0.35 ± 1.00 mmol/L, p