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Annual General Practitioner Study Day 2012. Men’s Health Workshop Managing side effects of male cancer therapy Dr Conleth Murphy, Consultant Medical Oncologist. Prostate cancer therapies. Endocrine therapies ADT: Orchiectomy or LHRH analogues Anti-androgens: bicalutamide (casodex)
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Annual General Practitioner Study Day 2012 Men’s Health Workshop Managing side effects of male cancer therapy Dr Conleth Murphy, Consultant Medical Oncologist
Prostate cancer therapies • Endocrine therapies • ADT: Orchiectomy or LHRH analogues • Anti-androgens: bicalutamide (casodex) • Chemotherapy • Docetaxel (Taxotere) • Cabazitaxel • Novel therapies • Abiraterone (Zytiga)
Cognitive dysfunction Hot flashes Loss of libido Anaemia Cardiovascular effects Worsening of diabetes Weight gain Sarcopaenia Erectile dysfunction Osteoporosis Androgen Deprivation Therapy
Side effects of ADT • Hot flashes • Acupuncture1, venlafaxine2, medroxyprogesterone acetate2 (20mg/day), cyproterone2 (androcur), gabapentin. • Anaemia • Monitor B12, folate, TIBC. Avoid EPO • Metabolic syndrome and cardiovascular health • 50% of men on long term ADT have metabolic syndrome. • Monitor BP, lipids and glucose. • Encourage diet and resistance exercise. • Cardiology review for men with pre-existing IHD • Frisk J, Spetz AC, Hjertberg H, Petersson B, Hammar M. Two modes of acupuncture as a treatment for hot flashes in men with prostate cancer—a prospective multicenter study with long-term follow-up. European Urology. 2009;55(1):156–163 • Irani J, Salomon L, Oba R et al. Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial, The Lancet Oncology, Volume 11, Issue 2, February 2010, Pages 147-154
Osteoporosis • Osteoporosis is common • ~35% of hormone-naïve men with prostate CA • ~80% after 10 years of ADT • Baseline DEXA • Repeat at least every 2 years • Weight bearing and resistance exercise • Calcium 1200mg + Vit D 800 u daily • Zoledronic acid 4mg IV yearly • Alendronate 70mg weekly orally • Denosumab 60mg S/C q6/12 reduced fracture risk. www.nof.org/professionals/clinical-guidelines http://www.shef.ac.uk/FRAX/tool.jsp?country=1
Chemotherapy • Up to 10 cycles of docetaxel • Febrile neutropaenia: reduced with neulasta • Nail changes: cold gloves can help • Neuropathy: dose reduction, pregabalin • Watery eyes: lubricants, steroid eyedrops, intervention for canal stenosis • Anaemia: correct deficiencies, consider EPO • Steroids reduce fluid retention • Please call with any concerns • Continue LHRH analogue throughout Rx • Cabazitaxel: similar but high rates diarrhoea and neutropaenia
Abiraterone • Novel oral inhibitor of androgen synthesis • Improves survival c/w best supportive care • 4x 250mg tablets daily 2 hrs after food • Prednisolone 10mg daily • Oedema • Hypertension • Abnormal LFTs • Hypokalaemia • Check BP, LFTs, U&E every 2 weeks for 3 months