Androgen deprivation therapy, insulin resistance, and cardiovascular mortality: An inconvenient truth

被引:93
作者
Basaria, Shehzad [1 ,2 ]
机构
[1] Johns Hopkins Univ, Sch Med, Div Endocrinol & Metab, Baltimore, MD 21224 USA
[2] Johns Hopkins Univ, Sch Med, Div Oncol, Baltimore, MD 21224 USA
来源
JOURNAL OF ANDROLOGY | 2008年 / 29卷 / 05期
关键词
prostate; androgen deprivation; cardiovascular mortality; insulin resistance; metabolic syndrome;
D O I
10.2164/jandrol.108.005454
中图分类号
R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
摘要
Prostate cancer (PCa) is the most common cancer in men. Androgen deprivation therapy (ADT) is used in the treatment of locally advanced and metastatic PCa. Although its use as an adjuvant therapy has resulted in improved survival in some patients, ADT has negative consequences. Complications like osteoporosis, sexual dysfunction, gynecomastia, and adverse body composition are well known. Recent studies have also found metabolic complications in these men. Studies show that short-term ADT (36 months) results in development of hyperinsulinemia without causing hyperglycemia. Studies of men undergoing long-term (>= 12 months) ADT reveal higher prevalence of diabetes and metabolic syndrome compared with controls. In addition, men undergoing ADT also experience higher cardiovascular mortality. Long-term prospective studies of ADT are needed to determine the timing of onset of these complications and to employ strategies to prevent them. In the meantime, baseline and serial screening for fasting glucose and other cardiac risk factors in men receiving ADT is prudent. In selected cases, glucose tolerance testing and cardiac evaluation may be required.
引用
收藏
页码:534 / 539
页数:6
相关论文
共 38 条
[11]   Sex hormones influence on the immune system: basic and clinical aspects in autoimmunity [J].
Cutolo, M ;
Sulli, A ;
Capellino, S ;
Villaggio, B ;
Montagna, P ;
Seriolo, B ;
Straub, RH .
LUPUS, 2004, 13 (09) :635-638
[12]   Influence of androgen suppression therapy for prostate cancer on the frequency and timing of fatal myocardial infarctions [J].
D'Amico, Anthony V. ;
Denham, James W. ;
Crook, Juanita ;
Chen, Ming-Hui ;
Goldhaber, Samuel Z. ;
Lamb, David S. ;
Joseph, David ;
Tai, Keen-Hun ;
Malone, Shawn ;
Ludgate, Charles ;
Steigler, Allison ;
Kantoff, Philip W. .
JOURNAL OF CLINICAL ONCOLOGY, 2007, 25 (17) :2420-2425
[13]   Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia [J].
Dockery, F ;
Bulpitt, CJ ;
Agarwal, S ;
Donaldson, M ;
Rajkumar, C .
CLINICAL SCIENCE, 2003, 104 (02) :195-201
[14]   The metabolic syndrome [J].
Eckel, RH ;
Grundy, SM ;
Zimmet, PZ .
LANCET, 2005, 365 (9468) :1415-1428
[15]  
Garnick MB, 2004, J CLIN ONCOL, V22, p401S
[16]  
Haffner SM, 1996, AM J EPIDEMIOL, V143, P889
[17]   DECREASED TESTOSTERONE AND DEHYDROEPIANDROSTERONE-SULFATE CONCENTRATIONS ARE ASSOCIATED WITH INCREASED INSULIN AND GLUCOSE-CONCENTRATIONS IN NONDIABETIC MEN [J].
HAFFNER, SM ;
VALDEZ, RA ;
MYKKANEN, L ;
STERN, MP ;
KATZ, MS .
METABOLISM-CLINICAL AND EXPERIMENTAL, 1994, 43 (05) :599-603
[18]   Studies on prostate cancer II The effects of castration on advanced carcinoma of the prostate gland [J].
Huggins, C ;
Stevens, RE ;
Hodges, CV .
ARCHIVES OF SURGERY, 1941, 43 (02) :209-223
[19]   Cancer statistics, 2007 [J].
Jemal, Ahmedin ;
Siegel, Rebecca ;
Ward, Elizabeth ;
Murray, Taylor ;
Xu, Jiaquan ;
Thun, Michael J. .
CA-A CANCER JOURNAL FOR CLINICIANS, 2007, 57 (01) :43-66
[20]   Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer [J].
Keating, Nancy L. ;
O'Malley, A. James ;
Smith, Matthew R. .
JOURNAL OF CLINICAL ONCOLOGY, 2006, 24 (27) :4448-4456