©TheCanadian Journal ofUrology™: International Supplement, April 2014
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after another cycle of ADT, ADTmay be halted again
and theprocess repeated.ProgressionoccurswhenPSA
or symptomatology is not suppressedby a full cycle of
ADT and these patients should be considered to have
CRPC. It is uncertainwhether outcomes are different
whenaLHRHagonistorantagonistareusedandwhether
there is benefit in adding a non-steroidal antiandrogen
for combined androgen blockade. The role of LHRH
antagonists in IADT are being currently examined in
multipleclinical trials.
AswithCADT,IADTwarrantsaproactiveapproach
to ADT-related complications. Cardiovascular,
metabolic, and bone complications that are ADT-
relatedaresimilar to thoseexperiencedby thegeneral
population and familiar to primary care physicians.
Accordingly, prescribers of ADT should ensure that
patientsarealso followingupappropriatelywith their
primary carephysicians for thediagnosis, treatment,
andpreventionof thesecomplications. Grossmanand
Zajac
37
have suggested someways thatADTpatients
shouldbemonitoredand treatedwithrespect to these
complications,Table1. Knowledgetransferandcareful
care coordination with primary care physicians is
needed to facilitate the comprehensive care required
bypatients receivingADT.
TABLE1.
Followupofnon-urologic androgendeprivation therapy complications. Modified fromGrossman
andZajac.
37
Complication
Recommendations
Metabolic and
Routinely assess:
cardiovascular
• BMI,waist circumference, bloodpressure
complications
• Screening for anemia, glucose intolerance anddyslipidemia
Manage:
• Lifestyle interventions includingsmokingcessation,exerciseanddietarymodification
• Medications for control of bloodpressure, diabetes anddyslipidemia
Skeletal
Routinely assess:
complications
• Risk factors for osteoporosis
• Osteoporosis fracture risk stratificationwith tools such as FRAX
(
• Assess falls risk
• Measure serum calcium, creatinine, vitaminD, liver function andTSH
• MeasurebonemineraldensitywithDEXA. Thoracolumbarspinex-rays inmenwith
osteopenia (T-score<-1.5)
Manage:
• Lifestyle interventionssuchassmokingcessation, limitingalcohol intake,andweight-
bearing exercises
• Supplement calcium (1200mg elemental calcium) andvitaminD (800 IU) intake
• Treat appropriate patients with bisphosphonates or denosumab based on DEXA
T-score, estimatedosteoporosis fracture risk (FRAX) andhistoryof fragility fracture
DEXA=dual energyx-ray absorptiometry
Disclosure
The authorshavenopotential conflict of interest.
35
DasonETAL.
