Introduction: Androgen deprivation therapy (ADT) is widely used around the world for the treatment various stages of prostate cancer. Androgen deprivation therapy (ADT) in men with prostate cancer (PCa) increased chance of developing metabolic disorders in insulin sensitivity, lipid levels, glucose metabolism, body composition (increases fat accumulation concurrently with a decrease in lean mass). These changes are the risk factors for the development of adverse cardiovascular events, including fatal ones.
Objective: To study the development of disorders in glucose metabolism during various regimens of ADT.
Materials and methods: The study included 115 patients with metastatic PCa, observed from 2014 to 2017 in the D.D. Pletneva State Clinical Hospital. Patients were randomised into 2 groups: group 1 (n=62) received monotherapy with gonadotropin-releasing hormone agonist (aGnRH), group 2 (n=53) received therapy with aGnRH and antiandrogens (maximal androgen blockade (MAB). Among the group 1 mean age was 64.2 years, among the group 2 mean age was 67.5 years. Evaluation of metabolic changes was performed before the start of therapy, 6 months and 1 year after the start of therapy, according to the following parameters: weight, body mass index (BMI), waist circumference (WC), fasting blood glucose level and oral glucose tolerance test.
Results: In both groups, comparable changes in the parameters were detected. After 12 months of therapy there was an increase in body weight by 6.56% in the aGnRH group (P=0.041) and by 6.87% in the MAB group (P=0.045). BMI increased by 6.19 (P=0.054) and by 7.62% (P=0.036), respectively, WC increased by 5.1 (P=0.025) and 4.48% (P=0.013), respectively. Changes in the parameters of glucose metabolism were estimated after 6 and 12 months of therapy. Fasting glycemia increased by 2% in the aGnRH group (P <0.05) and 2.36% (P=0.055) in the MAB group in 6 months, and in 12 months it increased by 4.07 and 3.7% (P <0.05), respectively. In the aGnRH group in 10% patiens diagnosed new cases of diabetes mellitus (DM) and in 10% impaired glucose tolerance during treatment period, therefore 20% of patients demonstrated glucose metabolism disorders during the year of therapy, in the MAB group DM manifested in 8% of patients, impaired glucose tolerance in 10%.
The conclusion: The MAB and monotherapy aGnRH therapy were associated with increase in body weight, WC, impaired of glucose metabolism in the early time (6 months of continuous therapy). It is important to initiate further prospective studies, to provide opportunities to manage these adverse changes.
18 - 21 May 2019
European Society of Endocrinology