Androgens and prostate cancer; pathogenesis and deprivation therapy - 19/09/13

Doi : 10.1016/j.beem.2013.05.001

Mathis Grossmann, MD, PhD, FRACP ^a,^b,^⁎ : Associate Professor, Principal Research Fellow, Endocrinologist, Ada S. Cheung, MBBS, FRACP, PhD ^a,^b : Student, Endocrinologist, Jeffrey D. Zajac, MBBS, PhD, FRACP ^a,^b : Professor of Medicine, Director
^a Dept. of Medicine, Austin Health, University of Melbourne, Victoria, Australia
^b Dept. of Endocrinology, Austin Health, Victoria, Australia

^∗Corresponding author. Dept. of Medicine, Austin Health, Studley Road, Heidelberg, VIC 3084, Australia. Tel.: +61 394965000; Fax: +61 394575485.

Abstract

Although androgen receptor signaling is critical for prostate cancer growth and survival, evidence supporting a favorable risk–benefit ratio of androgen deprivation therapy (ADT) is currently limited to men with high-risk or metastatic disease. This is in part because ADT has been associated with a number of constitutional and somatic side effects, consistent with the widespread tissue expression of sex steroid receptors. ADT is the most common contemporary cause of severe hypogonadism, and men receiving this therapy represent a unique model of severe sex steroid deficiency with a defined time of onset. This review will present an update on the role of ADT in the treatment of prostate cancer, will summarize recent evidence regarding ADT-associated adverse effects with particular emphasis on cardiometabolic and musculoskeletal health, and will provide recommendations for further research.

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Keywords : androgen deprivation therapy, prostate cancer, osteoporosis, sarcopaenia, insulin resistance, testosterone