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Can exercise ameliorate the increased risk of cardiovascular disease and diabetes associated with ADT?

Nature Clinical Practice Urology volume 5, pages 306–307 (2008)Cite this article

Androgen deprivation therapy (ADT) in the form of gonadotropin-releasing hormone (GnRH) agonists is being increasingly used in the management of prostate cancer, particularly as adjuvant treatment and for patients with early PSA relapse. ADT is, however, associated with a number of adverse effects, including reduced bone mass, increased risk of fracture at multiple sites, reduced lean mass and muscle strength, and increased fat mass: these effects compromise physical function, independence, and quality of life.1

Apart from these well-established adverse effects of ADT, accumulating evidence indicates that ADT is also associated with substantial cardiovascular and metabolic complications, which can affect patients' quality of life and overall survival. Four studies published within the last 2 years provide strikingly similar findings of these increased cardiovascular and metabolic risks associated with ADT, and highlight the need for strategies to counter treatment-induced morbidity and mortality.2,3,4,5 In a large, population-based cohort of men aged ≥66 years with localized prostate cancer, Keating et al.2 examined whether ADT in the form of a GnRH agonist or bilateral orchiectomy was associated with an increased incidence of cardiovascular disease and diabetes. Using Surveillance, Epidemiology and End Results (SEER) Medicare data, 73,196 men were observed for up to 10 years. Cox proportional hazards models, adjusted for a number of potential confounders, showed that GnRH agonist administration was associated with an increased risk of coronary heart disease (CHD; 16%), myocardial infarction (MI; 11%), sudden cardiac death (16%) and diabetes (44%). Moreover, the increased risk of incident CHD and diabetes was apparent with as little as 1–4 months' treatment. These findings have been supported by Saigal and colleagues,3 who also examined the risk of cardiovascular morbidity using SEER Medicare data: they found that patients who received ADT had a 20% increased risk of cardiovascular morbidity, and this increased risk was observed within the initial 12 months of ADT.

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Acknowledgements

We would like to acknowledge The Cancer Council of Western Australia and the Prostate Cancer Foundation of Australia.

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Authors and Affiliations

  1. DA Galvão is a Research Fellow and RU Newton is the Professor of Exercise and Sports Science at the School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, Western Australia,,

    Daniel A Galvão & Robert U Newton

  2. DR Taaffe is a Senior Lecturer at the School of Human Movement Studies, University of Queensland, Brisbane, Queensland, and,

    Dennis R Taaffe

  3. N Spry is a Clinical Associate Professor at the Department of Radiation Oncology, Sir Charles Gairdner Hospital and at the Faculty of Medicine, University of Western Australia, Nedlands, Western Australia, Australia.,

    Nigel Spry

Authors
  1. Daniel A Galvão
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  2. Robert U Newton
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  3. Dennis R Taaffe
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  4. Nigel Spry
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Corresponding author

Correspondence to Robert U Newton.

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The authors declare no competing financial interests.

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Galvão, D., Newton, R., Taaffe, D. et al. Can exercise ameliorate the increased risk of cardiovascular disease and diabetes associated with ADT?. Nat Rev Urol 5, 306–307 (2008). https://doi.org/10.1038/ncpuro1104

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