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Symptoms & Sequelae of Chronic Androgen Deprivation

Symptoms & Sequelae of Chronic Androgen Deprivation. Dr Charles Chabert. Background. Huggins & Hodges in 1946 Orchidectomy Oestrogen LHRH analogues. Sequelae of ADT. Hot flushes Osteoporosis Anaemia Sexual dysfunction Changes in BMI, metabolism & lipid profile Cognitive impairment.

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Symptoms & Sequelae of Chronic Androgen Deprivation

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  1. Symptoms & Sequelae of Chronic Androgen Deprivation Dr Charles Chabert

  2. Background Huggins & Hodges in 1946 Orchidectomy Oestrogen LHRH analogues

  3. Sequelae of ADT • Hot flushes • Osteoporosis • Anaemia • Sexual dysfunction • Changes in BMI, metabolism & lipid profile • Cognitive impairment

  4. Hot Flushes 80% on ADT Most bothersome Alteration in hypothalamic feedback

  5. Hot Flushes- Treatment • Diethylstilbesterol • Megestrol Acetate • Cyproterone Acetate • Medroxyprogesterone Acetate

  6. Osteoporosis Bone density reduction 2.5x increase in fracture Measurable changes after 9 months @ 1 year 3-5% bone mineral density Thrasher et al. Oncology 2004

  7. Osteoporosis- Aetiology Testosterone mediates Osteoblastic proliferation Increase bone matrix formation Stimulates TGF-Beta & IGF-1 Testosterone conversion to Oestradiol Reduced oestradiol levels in ADT Thrasher et al. Oncology 2004

  8. Osteoporosis- Prevention Intermittent ADT Cease smoking Moderate alcohol & caffeine Vit D & Ca supplements Weight bearing exercise Thrasher et al. Oncology 2004

  9. Osteoporosis - treatment Bisphosphonates Inhibit osteoclast Zoledronic acid Thrasher et al. Oncology 2004

  10. Anaemia Underlying cause of fatigue Normochromic, normocytic Reduced testosterone – reduced EPO 90% ADT have 10% reduction in HB 13% reduction >25% Strum et al BJU 1997; 79: 933

  11. Sexual Dysfunction Occurs in most on ADT Reduced libido 2nd to low testosterone Mechamism behind ED poorly understood Trial intermittent ADT or antiandrogen

  12. Changes in BMI, Metabolism & Lipid Profile Median wt gain 6kg BMI increase 2.4% after 48 weeks 9% increase cholesterol 26.5% increase in serum triglycerides Smith et al J Clin Endo 2002; 87: 599

  13. Cognitive Impairment Detrimental effect on memory, attention and verbal fluency Green et at BJU 2002; 90:427

  14. Conclusion Council patients on ADT Lifestyle modifications Baseline Bone densiometry

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