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Bone Health
ADT has been associated with hypogonadal bone loss in men. To maximize bone health in men undergoing ADT,
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guidelines recommend :
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• Supplemental calcium and vitamin D3
• Additional treatment for men ≥ 50 years with low bone mass and:
– 10-year probability of hip fracture ≥ 3%, or
– 10-year probability of major osteoporosis-related fracture ≥ 20%
• Baseline bone mineral density test (re-test after 1 year of treatment)
• Consider anti-resorptive drugs if the patient’s risk of fracture warrants drug therapy

ADT and Sexual Dysfunction

Loss or absence of libido is common in men undergoing ADT, although some men do maintain sexual desire and
function. Men should be encouraged to consult a psychology or counselling service with a focus on sexual health.
Erectile dysfunction may occur, and treatment options include:
• PDE-5 inhibitors
• Intracavernosal injection therapy
• Vacuum-assisted devices
• Topical agents

Mood Changes
Men who are undergoing treatment with ADT often describe a number of personality changes, including worsening
of mood, feeling more emotional, greater irritability, and more prone to crying than before they started treatment.
Studies are conflicting as to whether ADT increases symptoms of depression in men with prostate cancer; however,
the mood changes that occur in men undergoing ADT can often be confused by their family as depression, and
open discussion can be very helpful. Monitoring for mood changes is therefore advisable for all patients with
prostate cancer.

Neurocognitive Changes
If neurocognitive changes are suspected, patients should have a thorough workup by their primary care provider.

Summary - Monitoring During ADT
ADT is foundational in the treatment of prostate cancer, and compliance to therapy is important to ensure
efficacy. Ensuring that the side effects associated with ADT are addressed and minimized is one way to aid
compliance to treatment. Men with prostate cancer are generally followed up every 3 to 6 months, under a
shared-care approach. While a patient is undergoing ADT for prostate cancer, it is important to routinely measure
prostate-specific antigen (PSA) and testosterone to ensure the efficacy of their treatment and monitor for adverse
events. It is important to also ensure compliance with calcium and vitamin D supplementation.

Feedback from the caregiver can offer additional insight into adverse event and compliance issues. In some cases,
it may be necessary to re-evaluate and/or modify therapy.

References
1. Frisk J. Maturitas 2010;65:15-22. 7. NCCN. Prostate Cancer (Version 1.2021).
2. Dalal S, Zhukovsky DS. J Supportive Oncol 2006;4:315–20, 325. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf.
Accessed February 3, 2021
3. Richardson MK. Menopause 2013;20:980–2. 8. Bhatia N, et al. Circulation 2016;133:537-41.
4. Kaplan M, Mahon S. Clin J Oncol Nurs 2014;18 Suppl:59-67. 9. Wein T, et al. CMAJ 2020;192:E302-E311.
5. Focht BC, et al. Ann Behav Med 2018;52:412-28. 1 0. Leder BZ, et al. J Clin Endocrinol Metab 2001;86:511-6.
6. Taaffe DR, et al. Eur Urol 2017;72:293-9.

Reviewed and approved by the Urology Nurses of Canada

This tool has been developed through an unrestricted educational grant from Sanofi Inc.