Management of complications of androgen deprivation therapy in the older man

Abstract

Prostate cancer is the most common malignancy in older men. With the aging of the population, the number of older men with prostate cancer will grow rapidly. Androgen deprivation therapy (ADT) is the mainstay of treatment for men with systemic disease and is increasingly utilized as primary therapy or in combination with other therapies for localized disease. Side effects of therapy are multifold and include hot flashes, osteoporosis, and adverse psychological and metabolic effects. Recent research has illustrated that ADT can negatively impact the functional, cognitive, and physical performance of older men. Patients with prostate cancer, despite recurrence of the disease, have a long life expectancy and may be subjected to the side effects of ADT for many years. This review highlights the complications of ADT and approaches to management. We also provide recommendations for assessment and management of ADT complications among the most vulnerable and frail older male patients.

Fig. 1

Prevention and treatment of osteoporosis in the older man on ADT.

Fig. 2

Schema of CGA use to manage side effects of ADT. Those persons with no apparent impairments are “fit” and should have no functional dependence, no comorbidities, and no geriatric syndromes. Vulnerable persons may have some dependence in instrumental activities of daily living, non-life threatening comorbidities, and no significant geriatric syndromes other than mild depression or a mild memory disorder. Frail persons can be characterized as those persons aged 85 years and over, those older persons with a dependence in an activity of daily living, three or more significant comorbidities or one comorbidity that is associated with limitation of daily life responsibilities. These definitions are adapted from Balducci and Extermann [188] and Basso et al. [189].