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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

Bone health Avoid alcohol while on therapy Alcohol consumption Yes No
Decreased bone mineral density
Increase risk for osteoporosis Calcium and vitamin D supplementation Receiving recommended doses?
Increased risk for clinical fractures * Recommend calcium 1200 mg PO daily from dietary sources and Yes No
supplements and vitamin D 800-2000 IU PO daily
Baseline calcium level Screening? Yes No
Osteopenia? Yes No
Baseline 25-hydroxyvitamin D level
Osteoporosis? Yes No
Osteoporosis screening and management
Treatment indicated? Yes No
For men with expected duration of therapy >1 year:
Details of treatment:
Baseline bone mineral density
*Men on ADT are at increased risk for osteoporosis and clinical fractures. Recommend
screening and management of osteoporosis as per the 2010 clinical practice guidelines for
the diagnosis and management of osteoporosis in Canada for all men on ADT *DXA should
be repeated every 2–3 years in men at low risk for fractures receiving ADT. In men with
osteopenia or those at moderate or high risk for fractures, DXA should be repeated every
1–2 years until treatment cessation. Patients started on pharmacological therapy should
have followup DXA to assess for treatment response.
Hot flashes Identify and avoid triggers Hot flashes Yes No
Feeling hot and experiencing sweats Various medications are available and may help your symptoms
Consider acupuncture
Breast events If you are experiencing this side effect let your prostate cancer doctor Breast events Yes No
Breast growth and/or tenderness know. There may be treatment options available, including hormone
therapies, radiation and surgery.

Cognitive function Monitor your symptoms and let your providers know if you experience Changes in cognition Yes No
Possibly decreased concentration, any changes.
memory loss, dementia and depression

Fatigue and anemia Exercising regularly helps with fatigue. Fatigue Yes No
Feeling tired and low hemoglobin levels Work up secondary causes of anemia and referral to hematology if
hemoglobin level drops more than 10mg/dL Last HGB level
Impaired sexual function You may benefit from seeing a sex therapist or medications and other Sexual dysfunction? Yes No
Decreased penile and testicular size interventions to help with sexual function
Loss of sexual desire Discuss with your prostate cancer doctor if intermittent ADT may be
Decreased sensitivity to sexual appropriate for you
stimulation
Erectile dysfuncton

Quality of life Exercising regularly helps improve quality of life while you are on ADT.
Multiple domains Discuss with your prostate cancer doctor if intermittent ADT may be
appropriate for you

Source: Kokorovic A, So AI, Rendon R et al. Canadian Urological Association guideline on androgen deprivation therapy: Adverse events and management strategies. Can Urol Assoc
J. 2021;15(6):E307-E322. doi:10.5489/cuaj.7355
Reference: Papaioannou A, Morin S, Leslie WD et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ. 2010;182:
1864–73. doi: 10.1503/cmaj.100771

This tool was developed by the CUA and made possible with funding provided by Abbvie, Ferring and Sanofi in collaboration with Tolmar.