State-of-the-Art Lecture: Emerging Toxicities Of Hormonal Therapy

Main Category: Urology / Nephrology
Also Included In: Endocrinology
Article Date: 29 Jun 2008 - 1:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

ORLANDO, FL (UroToday.com) - Dr. Matthew Smith of Harvard University addressed toxicities of hormonal therapy. Initiating ADT for men with CaP brings challenges. Many have indolent disease and co-morbid conditions and there is inadequate information about benefits.

Initial use of DES was abandoned when the two-fold increase in thromboembolic events were noted. He said we must still assess present GnRH agonists use for any toxicities as well. For most men CaP is indolent. GnRH agonists use has increased to include one-third of men with CaP. GnRH agonist use results in fatigue, anemia, osteoporosis, decreased libido and vasomotor flushing.

In this talk he addressed obesity. It has a prevalence of 32% in the US. GnRH agonists decrease muscle mass by 4% and increase fat mass by 10% in one of his studies. This resulted in a 3kg increase in fat mass over one year. This fat mass increase is primarily subcutaneous. This also relates to increases in total cholesterol and triglycerides. HDL cholesterol also increases and thus may have a neutral alteration in risk. Insulin sensitivity during GnRH agonists therapy was altered with insulin resistance noted after 12 weeks of treatment. This is an independent risk for cardiovascular disease. The metabolic syndrome is a specifically defined syndrome and has 5 components. It was noted that there is a greater prevalence of metabolic syndrome in men on GnRH agonists. However, in contrast to the metabolic syndrome the fat increase is subcutaneous with GnRH agonist patients as opposed to visceral fat in the metabolic syndrome.

He conducted a SEER data study of GnRH agonists, diabetes and CV disease. It included 73,000 Medicare patients. One-third received a GnRH agonist and 7% had bilateral orchiectomy. The adjusted HR's supported GnRH agonist exposure as increased risk for DM, CAD, MI, and sudden death. This was confirmed by a second study. A CaPSURE study showed a 6% vs. 2% increased risk of CV deaths in men treated with radical prostatectomy plus GnRH agonists vs. RP alone, respectively. However, several other studies did not demonstrate a definitive link, so this needs further clarification.

Dr. Smith concluded that use of GnRH agonists should be carefully weighted against the risks.

Presented by Matthew Smith, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2008 - UroToday