Department of Medicine, Austin Health/Northern Health, University of Melbourne, Heidelberg, Victoria, Australia.
Clin Endocrinol (Oxf). 2011 Mar;74(3):289-93. doi: 10.1111/j.1365-2265.2010.03939.x.
Adverse effects of androgen deprivation therapy (ADT) are a consequence of the induced sex steroid deficiency. ADT increases fat mass leading to insulin resistance and diabetes, and accelerates bone loss causing increased fracture risk. Given the high prevalence of cardiovascular disease and reduced bone density in ADT-naïve men with prostate cancer, the benefits of ADT have to be carefully weighed against its side effects, especially as a diagnosis of prostate cancer does not alter the life expectancy for most men. Men commencing ADT should be counselled about and be carefully monitored for these and other ADT-induced complications, which include fatigue, sexual dysfunction, hot flushes and anaemia. ADT-associated side effects should be prevented and treated in order that ADT-induced toxicity does not outweigh its benefits. Future clinical trials are needed: first, to better define the effects of ADT on survival in men with localized prostate cancer or with biochemical prostate-specific antigen recurrence; second, to delineate ADT-associated harm, especially with respect to cardiovascular events and fractures; and third, to test the efficacy of interventions designed to minimize ADT-related adverse outcomes. Such information will be essential to better quantify the risk-benefit ratio of ADT in the individual man with prostate cancer.
雄激素剥夺疗法（ADT）的不良反应是诱导的性激素缺乏的结果。ADT 会增加脂肪量，导致胰岛素抵抗和糖尿病，并加速骨质流失，增加骨折风险。鉴于患有前列腺癌的 ADT 初治男性中心血管疾病和骨密度降低的高发率，ADT 的益处必须仔细权衡其副作用，尤其是因为诊断出前列腺癌并不会改变大多数男性的预期寿命。开始 ADT 的男性应该接受咨询，并仔细监测这些和其他 ADT 引起的并发症，包括疲劳、性功能障碍、热潮红和贫血。应预防和治疗与 ADT 相关的副作用，以避免 ADT 引起的毒性超过其益处。需要进行未来的临床试验：首先，更好地定义 ADT 对局限性前列腺癌或生化前列腺特异性抗原复发患者生存的影响；其次，阐明 ADT 相关的危害，特别是与心血管事件和骨折有关的危害；第三，测试旨在最小化 ADT 相关不良后果的干预措施的疗效。这些信息对于更好地量化个体前列腺癌患者 ADT 的风险效益比至关重要。
