Dealing with Side Effects of Hormone Therapy in Prostate Cancer Treatment

Hormone therapy is considered most effective treatment for Prostate Cancer but HT do have side effects too. The three main side effects of HT in prostate cancer are (1) loss of libido,(2) erectile dysfunction, and (3) metabolic syndrome. These side effects can be debilitating to the patient and consideration of minimizing these side effects is critical.

Hot flashes occur in 80% of patients and do not abate with time. Progestational agents are effective in minimizing hot flashes. Metabolic syndrome includes lipid abnormalities, weight gain, hypertension, coronary artery disease, and fatigue. These abnormalities are difficult to prevent, so early treatment with appropriate medication is critical. Institution of an aggressive exercise program is recommended to prevent the metabolic syndrome and fatigue.

Skeletal related events (SRE) are caused by osteoporosis and bone metastases. Osteoporosis is common in men on HT and continues over time. SREs are associated with worse overall survival. Bisphosphonates such as zoledronic acid are effective in preventing SREs and may improve survival in patients with CRPC by preventing a SRE.

Bisphosphonates are recommended in men with widespread metastatic disease especially if they involve weight bearing bones, and in symptomatic men. Bisphosphonates are not recommended for a rising PSA alone in men with CRPC. Depression and cognitive loss is common in men on HT. Early treatment with anti-depressants is recommended.

Intermittent HT will prevent many of the reversible side effects, but this treatment should be withheld until the randomized SWOG study on continuous vs. intermittent HT is published.