Prostate cancer can be treated in a variety of ways, including watchful waiting, surgery, radiation, chemotherapy, or hormone therapy. Treatment can vary from person-to-person, and can include one or more of the previously mentioned treatments. How prostate cancer is treated can depend on things like stage and grade of cancer, your general overall health, and your age.
Each treatment carries risks, and it’s important that your doctor discusses this with you before deciding on a course of treatment, and again afterward, to ensure that you take the necessary steps to stay healthy. Hormone therapy has been associated with metabolic syndrome, which has also been linked to high-grade prostate cancer.
What is Metabolic Syndrome?
Metabolic syndrome is a collection of risk factors for cardiovascular disease that has been associated with advanced prostate cancer and an increased risk of prostate cancer recurrence1. It has also been linked to various cardiovascular risks and diabetes, and has insulin resistance as a main feature.
What is ADT?
ADT, or androgen deprivation therapy, may also simply be called hormone therapy. Androgens are male hormones and can encourage prostate cancer growth. ADT aims to lower androgen levels or reduce the chance of them reaching cancer cells, in order to slow prostate cancer growth. Hormone therapy by itself, however, cannot cure prostate cancer2. There are various kinds of hormone therapies, and not everyone with prostate cancer will go on ADT. It’s often used when:
The cancer has spread and surgery or radiation cannot be used
The cancer has returned or remained, despite surgery or radiation
An individual is at higher risk, ie, has a high Gleason score or PSA level; in which case, it’s often used with radiation therapy as an initial treatment
Prior to radiation to shrink the existing cancer, for better treatment success
ADT and risk factors for Metabolic Syndrome
While ADT may be helpful for some people in treating prostate cancer, there are various side effects, with some being more serious. Side effects of ADT can include reduced libido, erectile dysfunction, osteoporosis, anemia, weight gain, fatigue, increased cholesterol levels, and depression2. Weight gain and high cholesterol levels are also factors in metabolic syndrome. Studies have found that lower levels of testosterone may promote insulin resistance, which can then increase the risk of developing metabolic syndrome1. This is especially true in men who receive long-term ADT.
Not only does ADT decrease insulin sensitivity, but it increases fat, decreases lean muscle mass, and increases serum triglycerides1. Even if you don’t have metabolic syndrome, these side effects can increase your risk of cardiovascular disease.
Important considerations for your health
If you have prostate cancer and your doctor brings up ADT, talk with her about whether it’s actually warranted, and whether it’s the best possible choice for your cancer, given the possible risks. Especially if you have one or more of the potential markers for metabolic syndrome, it’s important to review all the possible benefits and risks of a treatment that might exacerbate it.
Metabolic syndrome can be modified, and even prevented, with lifestyle changes, so it’s especially important to be aware of behaviors during and after prostate cancer treatment, especially if you receive ADT. Things like increasing physical activity and regular exercise, along with eating a healthy, balanced diet can help you maintain a healthy weight, decrease insulin resistance, and lower blood pressure – all of which combat the effects of metabolic syndrome3. Stress management is also important to maintain overall health, both physical and mental.
Talk to your doctor
Men who have had ADT for prostate cancer treatment are suggested to see their primary care physician 3-6 months after starting ADT, and at regular intervals after that to have certain lab tests done to monitor any cardiovascular risks. These tests and monitoring can include blood pressure, and lipid profile and glucose level1. If you have metabolic syndrome, talk with your doctor about what you can do to help minimize further health risks, and whether you might be a candidate for any medication for blood pressure or cholesterol levels.
Karzai F, Madan R, & Dahut W. Metabolic syndrome in prostate cancer: Impact on risk and outcomes. Future Oncol. 2016; 12(16): 1947-1955. Doi: 10.2217/fon-2016-0061
Hormone Therapy for Prostate Cancer. American Cancer Society website. https://www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html Published February 16, 2016. Updated July 18, 2018. Accessed August 28, 2018.
Metabolic Syndrome. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/diagnosis-treatment/drc-20351921 Published March 6, 2018. Accessed August 28, 2018.