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Adverse Effects of Hormone Therapy in Prostate Cancer

Insights From: Susan F. Slovin, MD, PhD, Memorial Sloan Kettering Cancer Center; Dipti Gupta, MD, MPH, Memorial Sloan Kettering Cancer Center
Published: Tuesday, Apr 02, 2019



Transcript: 

Susan F. Slovin, MD, PhD: Going into a chemical-induced menopause is not great for a lot of men. It’s interesting when we discuss adverse effects to really keep in mind that while there is a huge number of adverse effects that occur, it’s not guaranteed that the patient will develop each and every one. The most common of course is loss of sexual function, as well as loss of libido, and the hot flashes, or what we call vaso, vasomotor symptoms, that seem to be really exacerbated at night.

Interestingly, in addition to other potential adverse effects, including osteoporosis, we actually see patients develop a normochromic, normocytic anemia in about probably 5% to 10% of patients. It results in a mild decrease in hemoglobin level. So if a gentleman is anywhere from 14 to 15 g/dL, he may go down do 11 to 12 g/dL, or 12 to 13 g/dL. But I think what is very concerning—and really underscores how we need to communicate with our general medicine or primary care colleagues—is that very often patients will come in having been started on iron or vitamin B12 after being told that they’re horribly anemic, when in reality you need testosterone to make red blood cells. Ergo, we are causing this mild anemia. Similarly, patients can develop loss of muscle tone, they’re more fatigued, there are mood changes, and patients could become extremely temperamental; 1 moment tearful, the next minute very belligerent or short tempered. But more importantly is the metabolic syndrome that everybody talks about.

What’s important here is that if you look at the established literature, patients who have an elevated HDL [high-density lipoprotein] or LDL [low-density lipoprotein] to begin with would actually increase by another 10% to 15% even within their cholesterol. So there is a risk of somebody developing hypertriglyceridemia or hypercholesterolemia in already a pre-existing problem for that patient.

Similarly, they have increased abdominal girth. We call it centripetal obesity. A patient just the other day was complaining that he went up 2 waist sizes on his slacks and was very aggravated. People feel bloated; they just don’t feel right. And the problem with the fatigue is that instead of people going to the gym, what happens after the fatigue is that they don’t go to the gym and then they get a little bit more weight gain, and it just goes on to a vicious cycle. If you can maintain muscle tone, I think you’re doing yourself a tremendous favor.

Cognitive issues are also a complete concern for most people. There is a substantial body of literature, including several articles from the Journal of Clinical Oncology, within the last 2 years that suggest that patients answering deprivation therapy actually are more susceptible to cognitive changes.

Transcript Edited for Clarity
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Transcript: 

Susan F. Slovin, MD, PhD: Going into a chemical-induced menopause is not great for a lot of men. It’s interesting when we discuss adverse effects to really keep in mind that while there is a huge number of adverse effects that occur, it’s not guaranteed that the patient will develop each and every one. The most common of course is loss of sexual function, as well as loss of libido, and the hot flashes, or what we call vaso, vasomotor symptoms, that seem to be really exacerbated at night.

Interestingly, in addition to other potential adverse effects, including osteoporosis, we actually see patients develop a normochromic, normocytic anemia in about probably 5% to 10% of patients. It results in a mild decrease in hemoglobin level. So if a gentleman is anywhere from 14 to 15 g/dL, he may go down do 11 to 12 g/dL, or 12 to 13 g/dL. But I think what is very concerning—and really underscores how we need to communicate with our general medicine or primary care colleagues—is that very often patients will come in having been started on iron or vitamin B12 after being told that they’re horribly anemic, when in reality you need testosterone to make red blood cells. Ergo, we are causing this mild anemia. Similarly, patients can develop loss of muscle tone, they’re more fatigued, there are mood changes, and patients could become extremely temperamental; 1 moment tearful, the next minute very belligerent or short tempered. But more importantly is the metabolic syndrome that everybody talks about.

What’s important here is that if you look at the established literature, patients who have an elevated HDL [high-density lipoprotein] or LDL [low-density lipoprotein] to begin with would actually increase by another 10% to 15% even within their cholesterol. So there is a risk of somebody developing hypertriglyceridemia or hypercholesterolemia in already a pre-existing problem for that patient.

Similarly, they have increased abdominal girth. We call it centripetal obesity. A patient just the other day was complaining that he went up 2 waist sizes on his slacks and was very aggravated. People feel bloated; they just don’t feel right. And the problem with the fatigue is that instead of people going to the gym, what happens after the fatigue is that they don’t go to the gym and then they get a little bit more weight gain, and it just goes on to a vicious cycle. If you can maintain muscle tone, I think you’re doing yourself a tremendous favor.

Cognitive issues are also a complete concern for most people. There is a substantial body of literature, including several articles from the Journal of Clinical Oncology, within the last 2 years that suggest that patients answering deprivation therapy actually are more susceptible to cognitive changes.

Transcript Edited for Clarity
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