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Androgen Deprivation Therapy

Monitoring and Management of Adverse Events

Your doctor has recently started you on ADT. Although ADT is very important for the management of prostate cancer, it can
have some side effects that require monitoring and sometimes treatment. This sheet has been designed to identify some of
the side effects that may occur. Many of these side effects are managed by primary care providers.
Please show this to your prostate cancer doctor and your primary care provider at every clinic visit.
Patient and provider information

Patient name: Date of birth: MM/DD/YY

Prescriber and role: Urologist Medical oncologist Radiation oncologist Other

Primary care provider:
Prostate cancer diagnosis

Localized/locally advanced Biochemical recurrence Metastatic hormone sensitive Non-metastatic castrate resistant Metastatic castrate resistant
Date of initial prostate cancer diagnosis: MM/DD/YY Date (s) of progression: MM/DD/YY

Type of therapy: Medical Surgical (bilateral orchiectomy) Start date of medical therapy or date of surgery: MM/DD/YY
Expected duration of therapy: Less than 6 months 6 months to 3 years Life long
Details of ADT

Medical therapy details: Name of drug: Dose: Route: Frequency:

Administered by: Home injection program Prostate cancer doctor Primary care provider Other Continuous Intermittent
Other details:
Past medical history
Diabetes Dyslipidemia Hypertension Elevated BMI Cardiovascular disease Stroke Falls risk Other

Colour Legend Managed by PCP Managed by specialist Managed by PCP and specialist

ADT Adverse Events
Adverse event Management (assess every 6-12 months while on therapy) Date: MM/DD/YY
Cardiovascular disease Assess for symptoms of cardiovascular disease (eg. angina, SOB, Symptoms Yes No
Increased risk for cardiac events decreased exercise tolerance, symptoms of HF, claudication) Referral Yes No
Increased risk for stroke * Patients with a history of stroke or MI may be at increased risk for further major cardiovascular
Increased risk for DVT/PE events as a result of ADT use and may benefit from referral to cardio-oncology
Check and maintain good blood pressure control BP
Counsel regarding importance of smoking avoidance/cessation Smoker Yes No
Body composition Maintain a healthy weight
Increased BMI Weight (kg) Waist circumference (cm)
Increased percentage body fat Recommend 150 minutes of aerobic and resistance exercise per week,
Decreased muscle mass preferably in a supervised setting Height (cm) BMI (kg/m ) 2
Meeting goal? Yes No
Metabolic changes Assess lipid profile and treat dyslipidemia as per best practice LDL-C
Insulin resistance/glucose intolerance Assess glycemic control and treat hyperglycemia/diabetes as per
Increased risk for diabetes best practice nonHDL-C
Worse glycemic control Assess for metabolic syndrome and treat as per best practice On therapy? Yes No
Altered lipid profile HgBA1c %
Increased risk for metabolic syndrome
Oral GTT
Fasting BGL
On therapy? Yes No
Metabolic syndrome? Yes No