Some high-powered reviews on ADT side effect management

Adverse effects of androgen deprivation therapy and strategies to mitigate them. By Nguyen et al. 2014


Key sentence from the paper: “ADT…has…adverse effects on bone, metabolic, cardiovascular, sexual, and cognitive health as well as body composition.


For the full abstract, see:     


Androgen deprivation therapy for prostate cancer: long-term safety and patient outcomes. By Ahmadi and Daneshmand et al. 2014 


Key sentence from the paper: “Given its widespread use, clinicians should be familiar with common side effects of this treatment.


For the full abstract, see:    


Commentary: These are two quite similar, highly detailed, reviews about ADT side effects and their management. Both papers provide a very comprehensive overview of the side effects of ADT and include a discussion of management strategies.

It is interesting to see where their recommendations are not identical. The papers differ slightly in terms of their recommendation for supplemental calcium and vitamin D. Ahmadi and Daneshmand recommend 1500 mg/day of calcium whereas Nguyen et al recommend “calcium intake of at least 1200 mg/day”. Similarly Ahmadi and Daneshmand recommend 800 IU/day of vitamin D whereas Nguyen et al recommend 800-1000 IU/day.

Neither paper discusses the indirect impact of ADT on the partners of prostate cancer patients.

Similarly, neither paper mentions the possibility of using transdermal estradiol to manage hot flashes. Admittedly this is an off-label use but it is becoming increasingly accepted since it is the indirect loss of estradiol that accounts for why patients on ADT experience hot flashes. Interestingly, Ahmadi and Daneshmand do recommend an off-label use of non-oral estrogen, such as transdermal estradiol, to preserve libido. 


 Nguyen PL, Alibhai SM, Basaria S, D'Amico AV, Kantoff PW, Keating NL, Penson DF, Rosario DJ, Tombal B, Smith MR. 2014. Adverse Effects of Androgen Deprivation Therapy and Strategies to Mitigate Them. European Urology. 2 August 2014 [Epub ahead of print]

 Ahmadi H, Daneshmand S. 2014. Androgen deprivation therapy for prostate cancer: long-term safety and patient outcomes. Patient related outcome measures 5:63-70.