Long-term androgen ablation therapy has well recognized side effects including anemia, bone mineral loss, decreased libido, weight gain, cognitive deficits, and glucose intolerance. The exact risk of the metabolic syndrome in these patients has not been well established.

In the August 20th, 2006 issue of the JCO, Braga-Basaria and colleagues from Johns Hopkins performed an assessment of the prevalence of the metabolic syndrome in patients treated for at least 12 months of androgen deprivation in comparison with 2 cohorts of men, one with prostate cancer (without ADT) and the other without prostate cancer.

Metabolic syndrome was defined as the fulfillment of 3 of the following 5 criteria: (1) fasting plasma glucose > 110 mg/dl, (2) serum triglyceride level of 150 mg/dl or greater, (3) serum HDL < 40 mg/dL, (4) waist circumference > 40 in., or (5) blood pressure of 130/85 or greater. Patients taking antihypertensives or lipid lowering drugs were considered positive for each criterion.

A cross-sectional analysis was performed of 20 men with prostate cancer treated with androgen ablation for 12 months or longer, 18 age-matched men with PSA recurrence after prostatectomy or radiation (who had not been treated with ADT), and 20 age-matched men without cancer and with normal serum PSA values.

The metabolic syndrome was present in 55% of men undergoing ADT, compared with 20% of non-ADT prostate cancer patients, and 20% of controls (P< 0.03). In particular, patients on ADT exhibited a higher risk for abdominal obesity (waist > 40 cm) (75% vs. 30%, p < 0.007), fasting glucose > 100 mg/dl (65% vs. 23%, p < 0.006) and a trend for higher triglycerides. There was no difference in the prevalence of hypertension or hypercholesterolemia between groups.

This simple and valuable study should raise awareness regarding disclosure of risks and prevention in patients undergoing androgen ablation therapy. Clearly the physician administering the drug should play a leadership role in involving our internal medicine colleagues early with the aim of preventing cardiovascular complications. Perhaps ordering a baseline CBC, fasting metabolic panel, HgbA1c, lipid panel, and an internal medicine consult should become the standard for all patients before long-term androgen ablation therapy.

By Ricardo F. Sánchez-Ortiz, MD

J Clin Oncol 24:3979-3983.

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