No votes yet
Journal Club

Androgen-Deprivation Therapy and Metabolic Syndrome in Men With Prostate Cancer

Joanne M. Harrington
Dawn C. Schwenke
Dana R. Epstein
Donald E. Bailey
ONF 2014, 41(1), 21-29 DOI: 10.1188/14.ONF.21-29

Purpose/Objectives: To examine the trajectory of changes in body composition and metabolic profile in men who receive androgen-deprivation therapy (ADT) for prostate cancer.

Design: Prospective longitudinal design with repeated measures.

Setting: Urban medical center in the southwestern United States.

Sample: 55 men starting radiation therapy for prostate cancer.

Methods: Changes in the parameters of metabolic syndrome were estimated with ADT (n = 31) and non-ADT (n = 24) groups by repeated-measures analysis of variance implemented by general linear mixed-effects models. Models included interactions between groups and follow-up time to test differences between the groups.

Main Research Variables: Body composition and metabolic variables.

Findings: The ADT group demonstrated a transient increase in waist circumference at the nine-month time point and significant changes in measures of insulin resistance were noted at the three month point. Values for diastolic and systolic blood pressure, plasma glucose, high-density lipoprotein, and triglycerides were not altered for either group. Differences in metabolic variables or measures of body composition did not differ significantly between the groups.

Conclusions: The findings demonstrate the development of insulin resistance in men receiving ADT as early as three months after starting ADT.

Implications for Nursing: Addressing survivorship concerns can lead to the development of nursing interventions designed to reduce adverse effects associated with ADT.


Alberti, K.G., Eckel, R.H., Grundy, S.M., Zimmet, P.Z., Cleeman, J.I., Donato, K.A., … Smith, S.C. (2009). Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. <i>Circulation, 120</i>, 1640-1645. doi:10.1161/CIRCULATIONAHA.109.192644

Alberti, K.G., Zimmet, P., & Shaw, J. (2005). The metabolic syndrome—A new worldwide definition. <i>Lancet, 366</i>, 1059-1061.

Alibhai, S.M., Duong-Hua, M., Sutradhar, R., Fleshner, N.E., Warde, P., Cheung, A.M., & Paszat, L.F. (2009). Impact of androgen deprivation therapy on cardiovascular disease and diabetes. <i>Journal of Clinical Oncology, 27</i>, 3452-3458. doi:10.1200/JCO.2008.20.0923

Basaria, S., Lieb, J., Tang, A.M., DeWeese, T., Carducci, M., Eisenberger, M., & Dobs, A.S. (2002). Long-term effects of androgen deprivation therapy in prostate cancer. <i>Clinical Endocrinology, 56</i>, 779-786.

Basaria, S., Muller, D.C., Carducci, M.A., Egan, J., & Dobs, A.S. (2006). Hyperglycemia and insulin resistance in men with prostate carcinoma who receive androgen-deprivation therapy. <i>Cancer, 106</i>, 581-587.

Braga-Basaria, M., Dobs, A.S., Muller, D.D., Carducci, M.A., John, M., Egan, J., & Basaria, S. (2006). Metabolic syndrome in men with prostate cancer undergoing long-term androgen-deprivation therapy. <i>Journal of Clinical Oncology, 24</i>, 3979-3983.

Choong, K., & Basaria, S. (2010). Emerging cardiometabolic complications of androgen deprivation therapy. <i>Aging Male, 13</i>, 1-9.

Cleffi, S., Neto, A.S., Reis, L.O., Maia, P., Fonseca, F., Wroclawski, M.L., … Tobias-Machado, M. (2011). Androgen deprivation therapy and morbid obesity: Do they share cardiovascular risk through metabolic syndrome? <i>Actas Urologicas Espanolas, 35</i>, 259-265.

Denis, L.J., & Griffiths, K. (2000). Endocrine treatment in prostate cancer. <i>Seminars in Surgical Oncology, 18</i>, 52-74.

Dockery, F., Bulpitt, C.J., Agarwal, S., Donaldson, M., & Rajkumar, C. (2003). Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia. <i>Clinical Science, 104</i>, 195-201.

Haffner, S.M. (2006). The metabolic syndrome: Inflammation, diabetes mellitus, and cardiovascular disease. <i>American Journal of Cardiology, 97</i>, 3A-11A. doi:10.1016/j.amjcard.2005.11.010

Haidar, A., Yassin, A., Saad, F., & Shabsigh, R. (2007). Effects of androgen deprivation on glycaemic control and on cardiovascular biochemical risk factors in men with advanced prostate cancer with diabetes. <i>Aging Male, 10</i>, 189-196.

Higano, C. (2012). Sexuality and intimacy after definitive treatment and subsequent androgen deprivation therapy for prostate cancer. <i>Journal of Clinical Oncology, 30</i>, 3720-3725. doi:10.1200/JCO.2012.418509

Keating, N.L., O'Malley, A.J., & Smith, M.R. (2006). Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. <i>Journal of Clinical Oncology, 24</i>, 4448-4456. doi:10.1200/JCO.2006.06.2497

Lage, M.J., Barber, B.L., & Markus, R.A. (2007). Association between androgen-deprivation therapy and incidence of diabetes among males with prostate cancer. <i>Urology, 70</i>, 1104-1108. doi:10.1016/jurology.2007.08.012

Lepor, H., & Shore, N.D. (2012). LHRH agonists for the treatment of prostate cancer: 2012. <i>Reviews in Urology, 14</i>, 1-12.

Levine, G.N., D'Amico, A.V., Berger, P., Clark, P.E., Eckel, R.H., Keating, N.L., … Zakai, N. (2010). Androgen-deprivation therapy in prostate cancer and cardiovascular risk: A science advisory from the American Heart Association, and American Urological Association: Endorsed by the American Society for Radiation Oncology. <i>CA: A Cancer Journal for Clinicians, 60</i>, 194-201. doi:10.3322/caac.20061

Myklak, K., & Wilson, S. (2011). An update on the changing indications for androgen deprivation therapy for prostate cancer. <i>Prostate Cancer, 2011</i>, 1-8. doi:10.1155/2011/419174

Ness-Abramof, R., & Apovian, C.M. (2008). Waist circumference measurement in clinical practice. <i>Nutrition in Clinical Practice, 23</i>, 397-404. doi:10.1177/0884533608321700

Nobes, J.P., Langley, S.E., & Laing, R.W. (2009). Metabolic syndrome and prostate cancer: A review. <i>Clinical Oncology, 21</i>, 1-9. doi:10.1016/j.clon.2008.11.013

Quon, H., & Loblaw, D.A. (2010). Androgen deprivation therapy for prostate cancer—Review of indications in 2010. <i>Current Oncology, 17</i>(Suppl. 2), S38-S44.

Rashid, M.H., & Chaudhary, U.B. (2004). Intermittent androgen deprivation therapy for prostate cancer. <i>Oncologist, 9</i>, 295-301.

Saylor, P.J., & Smith, M.R. (2009). Metabolic complications of androgen deprivation therapy for prostate cancer. <i>Journal of Urology, 181</i>, 1998-2008. doi:10.1016.j.juro.2009.01.047

Saylor, P.J., & Smith, M.R. (2012). Adverse effects of androgen deprivation therapy: Defining the problem and promoting health among men with prostate cancer. <i>Journal of the National Comprehensive Cancer Network, 8</i>, 211-222.

Shahani, S., Braga-Basaria, M., & Basaria, S. (2008). Androgen deprivation therapy in prostate cancer and metabolic risk for atherosclerosis. <i>Journal of Clinical Endocrinology and Metabolism, 93</i>, 2042-2049.

Shahinian, V.B., Kuo, Y.F., Freeman, J.L., Orihuela, E., & Goodwin, J.S. (2005). Increasing use of gonadotropin-releasing hormone agonists for the treatment of localized prostate cancer. <i>Cancer, 103</i>, 1615-1624.

Shuster, A., Patlas, M., Pinthus, J.H., & Mourtzakis, M. (2012). The clinical importance of visceral adiposity: A critical review of methods for visceral adipose tissue analysis. <i>British Journal of Radiology, 85</i>(1009), 1-10. doi:10.1259/bjr/38447238

Siegel, R., Naishadham, D., & Jemal, A. (2013). Cancer statistics, 2013. <i>CA: A Cancer Journal for Clinicians, 63</i>, 11-30. doi:10.3322/caac.21166

Smith, J.C., Bennett, S., Evans, L.M., Kynaston, H.G., Parmar, M., Mason, M.D., … Davies, J.S. (2001). The effects of induced hypogonadism on arterial stiffness, body composition, and metabolic parameters in males with prostate cancer. <i>Journal of Endocrinology and Metabolism, 86</i>, 4261-4267.

Smith, M.R. (2007). Androgen deprivation therapy for prostate cancer: New concepts and concerns. <i>Current Opinion in Endocrinology, Diabetes, and Obesity, 14</i>, 247-254.

Smith, M.R., Finkelstein, J.S., McGovern, F.J., Zietman, A.L., Fallon, M.A., Schoenfeld, D.A., & Kantoff, P.W. (2002). Changes in body composition during androgen deprivation therapy for prostate cancer. <i>Journal of Clinical Endocrinology and Metabolism, 87</i>, 599-603.

Smith, M.R., Lee, H., McGovern, F., Fallon, M.A., Goode, M., Zietman, A.L., & Finkelstein, J.S. (2008). Metabolic changes during gonadatropin-releasing hormone agonist therapy for prostate cancer. <i>Cancer, 112</i>, 2188-2194. doi:10.1002/cncr.23440

Smith, M.R., Lee, H., & Nathan, D.M. (2006). Insulin sensitivity during combined androgen blockade for prostate cancer. <i>Journal of Clinical Endocrinology and Metabolism, 91</i>, 1305-1308.

Trujillo, M.E., & Scherer, P.E. (2005). Adiponectin—Journey from an adipocyte secretory protein to biomarker of the metabolic syndrome. <i>Journal of Internal Medicine, 257</i>, 167-175. doi:10.1111/j.1365-2796.2004.01426.x

Yannucci, J., Manola, J., Garnick, M.B., Bhat, G., & Bubley, G.J. (2006). The effect of androgen deprivation therapy on fasting serum lipid and glucose parameters. <i>Journal of Urology, 176</i>, 520-525.