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Maintaining Quality of Life in Patients Undergoing

Androgen-Deprivation Therapy Across the

Continuum of Prostate Cancer

Androgen-deprivation therapy (ADT) plays an important role in the treatment of prostate cancer, by
decreasing androgen (testosterone) levels or blocking their action, in order to inhibit the growth of

prostate cancer. Because androgens affect a number of organs and tissues besides the prostate,
testosterone suppression from ADT is associated with a variety of adverse events.

Hot Flashes

Up to 80% of men on ADT have vasomotor symptoms, and up to 27% report hot flashes as the most bothersome side
effect of ADT. Management options that may offer relief include :
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• Limiting caffeine consumption
• Dressing in layers of light, removable clothing
• Acupuncture
• Exercise
• Drinking cold beverages instead of hot beverages/avoiding spicy foods

Occasionally, additional medications may be considered for severe hot flashes after discussion with the prescribing
physician*:

• Androcur (cyproterone acetate)
• Depo-Provera (medroxyprogesterone)
• Megace (megestrol acetate)
• Effexor XR (venlafaxine)
• Clonidine/gabapentin
• Paxil (paroxetine HCl)

* Note: These treatments have not been evaluated in randomized, controlled trials or been approved by Health Canada for this indication.

Weight Gain / Loss of Muscle Mass
Increased weight and body fat often occur in parallel with a decrease in muscle mass and strength. This puts
patients at increased risk for functional decline and metabolic syndrome. Interventions should focus on:
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• Resistance and aerobic exercises tailored to the patient’s individual tolerance
• Nutritional counselling with a registered dietician

Fatigue

Fatigue is a common problem for men with prostate cancer undergoing ADT. In addition to combating weight gain
and loss of muscle mass, exercise is helpful for reducing fatigue and enhancing vitality during ADT. Patients should
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be encouraged to stay active, engaged, and motivated, but also to take naps or rest when needed.

Gynecomastia
Gynecomastia is a common complication of ADT due to the altered ratio of circulating estrogens to androgens.
Gynecomastia usually resolves spontaneously after stopping hormonal therapy within the first year, but can
become permanent after that. Current therapeutic options include radiotherapy to the breast, subareolar
mastectomy, and medical treatment including tamoxifen.

Diabetes / Metabolic Syndrome

Screening for, and interventions to prevent/treat, diabetes are recommended for men receiving ADT, and
management strategies should be similar to those for the general population. The “ABCDE” paradigm was
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developed to control cardiovascular risk factors in cancer survivors and has been adapted for patients with
prostate cancer :
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A Awareness and ASA † †Acetylsalicylic acid (ASA) therapy is only recommended
for the secondary prevention of cardiovascular events
B Blood Pressure in patients with a history of symptomatic cardiovascular
disease, stroke, or peripheral artery disease, who have been
prescribed ASA by a physician. 9
C Cholesterol and Cigarettes

D Diet and Diabetes

E Exercise