Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Department of Medicine, University Health Network, Toronto, Canada.
Eur Urol. 2015 May;67(5):825-36. doi: 10.1016/j.eururo.2014.07.010. Epub 2014 Aug 2.
Androgen-deprivation therapy (ADT) is a key component of treatment for aggressive and advanced prostate cancer, but it has also been associated with adverse effects on bone, metabolic, cardiovascular, sexual, and cognitive health as well as body composition.
To review the current literature on the adverse effects of ADT and strategies for ameliorating harm from ADT.
The Medline database (through PubMed) was searched from inception to August 1, 2013, for studies documenting the side effects of ADT and for randomized and prospective trials of interventions to mitigate those side effects.
Adverse effects of ADT include decreases in bone mineral density; metabolic changes such as weight gain, decreased muscle mass, and increased insulin resistance; decreased libido and sexual dysfunction; hot flashes; gynecomastia; reduced testicle size; anemia; and fatigue. Several observational studies suggest an increased risk of diabetes and cardiovascular events, although most published studies report that ADT is not linked to greater cardiovascular mortality. Randomized trials have found value in treatments for some adverse effects including bone loss (bisphosphonates, denosumab, selective estrogen receptor modulators), markers of metabolic syndrome (exercise, diet, metformin), gynecomastia (tamoxifen, prophylactic radiation), muscle loss (resistance and aerobic exercise), and hot flashes (venlafaxine, medroxyprogesterone, cyproterone acetate, gabapentin).
ADT is often a necessary component of the treatment of aggressive prostate cancer, yet it has known harms that can impair health and quality of life. Clinicians should be aware of interventions that can help mitigate these adverse effects.
Androgen deprivation therapy is a critical component of the management of aggressive and advanced prostate cancer, but it causes adverse effects including bone loss, metabolic changes, gynecomastia, muscle loss, hot flashes, and possibly increased cardiovascular events. Clinicians should be aware of interventions that can help mitigate these adverse effects.
雄激素剥夺疗法（ADT）是治疗侵袭性和晚期前列腺癌的关键组成部分，但它也与骨骼、代谢、心血管、性和认知健康以及身体成分的不良影响有关。
综述 ADT 的不良影响以及减轻 ADT 危害的策略的现有文献。
从 1966 年至 2013 年 8 月 1 日，通过 Medline 数据库（通过 PubMed）搜索了记录 ADT 副作用的研究，并对减轻这些副作用的干预措施进行了随机和前瞻性试验。
ADT 的不良反应包括骨密度降低；代谢变化，如体重增加、肌肉减少和胰岛素抵抗增加；性欲和性功能下降；热潮红；男性乳房发育；睾丸缩小；贫血；疲劳。一些观察性研究表明，糖尿病和心血管事件的风险增加，尽管大多数已发表的研究报告称 ADT 与更高的心血管死亡率无关。随机试验发现，一些不良反应的治疗有价值，包括骨丢失（双膦酸盐、地舒单抗、选择性雌激素受体调节剂）、代谢综合征标志物（运动、饮食、二甲双胍）、男性乳房发育（他莫昔芬、预防性放疗）、肌肉减少（阻力和有氧运动）和热潮红（文拉法辛、醋酸甲羟孕酮、醋酸环丙孕酮、加巴喷丁）。
ADT 通常是治疗侵袭性前列腺癌的必要组成部分，但它有已知的危害，会损害健康和生活质量。临床医生应该了解可以帮助减轻这些不良反应的干预措施。
雄激素剥夺疗法是治疗侵袭性和晚期前列腺癌的重要组成部分，但它会引起包括骨丢失、代谢变化、男性乳房发育、肌肉减少、热潮红以及可能增加心血管事件在内的不良反应。临床医生应该了解可以帮助减轻这些不良反应的干预措施。
