40 / 52
© The Canadian Journal of Urology™; 23(Supplement 1); February 2016
The primary care physician’s role in the
monitoring and management of the potential
sequelae of the medical treatment of prostate
cancer: early and late
Victor Mak, MD,
1,2
Jack Barkin, MD
3
1
Division of Urology, Department of Surgery at Mackenzie Health, Richmond Hill, Ontario, Canada
2
Division of Urology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
3
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
MAKV, BARKIN J. The primary care physician’s role
in the monitoring and management of the potential
sequelae of the medical treatment of prostate cancer:
early and late.
Can J Urol
2016;23(Suppl 1):31-36.
Significant progress has been made in the management
of aggressive prostate cancer. The established old and
new treatments have resulted in the significant delay
in progression of disease, improvement of the quality of
life, as well as the increase in the overall survival of men
with advanced prostate cancer. However, these therapies
carry with them possible adverse effects that primary
care physicians are experienced in managing. Thus,
there is an increasing need for the urologist to involve
and partner closely with the primary care practitioner to
prevent, identify and manage the potential side effects of
these life-changing therapies.
Key Words:
prostate cancer, medical treatment,
castration resistant prostate cancer
While traditional and recently approved therapies for
advanced prostate cancer can improve quality of life as
well as progression-free and overall survival, treatment
relatedadverse events have beendocumented; therefore,
it is important for urologists to work closely with their
patients’ primary care physicians to monitor treatment
response, as well as the physical and biochemical side
effects of the therapies.
Androgen deprivation therapy (ADT)
There is an increasing number of published studies
demonstrating an association between ADT and an
increased risk of myocardial infarction, cerebrovascular
accident, sudden cardiac death, QTc prolongation,
diabetesmellitus, andmetabolic syndrome.
5
Patients on
ADT are encouraged to engage inphysical exercise daily
and maintain a healthy weight. Where appropriate,
patients might benefit from statin, glucose-lowering,
anti-hypertensive, and/or anti-platelet therapy.
6
It
has become very important for the family doctor to be
Introduction
Prior to 2010, therewere only two therapeutic strategies
for patients with advanced prostate cancer who fail
surgery and/or radiation: blockers of testicular
testosterone synthesis and docetaxel chemotherapy.
The traditional approach of androgen suppressionwas
with the use of luteinizing hormone-releasing hormone
(LHRH) agonist/antagonist injection therapy with or
without oral anti-androgen (or orchiectomy) in order
to achieve castrate levels of serum testosterone, defined
as < 50 ng/dL.
1
New evidence has shown that androgen precursors
in the tumor cell microenvironment may be converted
to testosterone and dihydrotestosterone (DHT).
Castration resistant prostate cancer (CRPC) tumor
cells may also increase the production of androgens
de novo to fuel their growth.
2-4
Address correspondence to Dr. Victor Mak, 22 Richmond
Street, Suite 203, Richmond Hill, ON L4C 3Y1 Canada
31