Side effects of androgen deprivation in prostate cancer and their correction: Systematic review

Introduction. Current treatment options for locally advanced and metastatic рrostate cancer offer high survival rates, making quality of life and management of comorbidities, which are often the primary cause of mortality in this cohort, a priority. Metabolic disturbances are one of the most common adverse effects of androgen deprivation therapy. Various treatment options have been described, but no single strategy has been proposed.

Aim. To update and systematize modern data on the pathogenesis of metabolic disorders induced by androgen deprivation therapy, and to analyze multidisciplinary approaches to their correction.

Materials and methods. A search, analysis, and systematization of relevant publications were conducted in the PubMed, Google Scholar, elibrary.ru, and cyberleninka.ru databases using the following keywords: “prostate cancer” “androgen deprivation therapy”, “metabolic disorders”, “sarcopenia”, “osteoporosis”, and “insulin resistance”. Conference abstracts, dissertation abstracts, and editorial comments were excluded. As a result, 79 of the 158 publications were selected and included in this review. 19 sources were used for the introduction, 60 sources for the main body, and 7 sources, previously mentioned in the main body, for the discussion.

Results. Based on this review, we propose recommendations for additional screening of prostate cancer patients receiving androgen-deprivation therapy and present promising approaches to reducing metabolic disturbances and increasing cancer-specific survival. Thus, glucagon-like peptide-1 receptor agonists and statins can not only correct metabolic disorders but also influence carcinogenesis. RANKL inhibitors also have a dual effect, breaking the vicious cycle of bone resorption in metastases. The positive impact of physical activity and nutritional modification on the quality of life and life expectancy of this patient cohort has been demonstrated. Modifications to androgen deprivation therapy through the use of an intermittent regimen or the use of releasing hormone antagonists can also reduce the risk of metabolic complications.

Conclusions. An integrated approach to monitoring and treatment improves the quality of life and life expectancy of prostate cancer patients receiving androgen deprivation therapy, as well as the outcomes of systemic antitumor therapy.

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