Side Effects of Endocrine Therapy and its Treatment in Cancer

Over 50% of prostate cancer patients treated with androgen deprivation therapy experience hot flushes within a few months of having commenced their treatment. The incidence of hot flushes tends to be even higher in the medical castrated patients. These hot flushes can be very annoying and severely disruptive to the patient’s quality of life

Treatment is often individualised to the patient’s needs. Both oral and transdermal oestrogens have been shown to be effective in reducing the incidence of hot flushes, however their high risk of thromboembolic side effects often makes them unfavourable choices. Progesterogenic agents such as megesterol acetate and cyproterone acetate have been shown to be efficacious in several clinical studies.

Their slightly more favourable side-effect profile over exogenous oestrogen replacement therapy often makes them the first-line choice in the treatment of hot flushes secondary to androgen deprivation therapy in prostate cancer. Skeletal complications secondary to osteoporotic bone loss following androgen deprivation therapy [38] are a common cause of morbidity and mortality in prostate cancer patients.

One study showed that approximately 14% of orchidectomised men experienced at least one osteoporotic fracture compared with only 1% of men without a history of androgen deprivation therapy (p = 0.001) fractures to be more common than traumatic or pathological types, with approximately 38% of the men surviving for more than 5 years after bilateral orchidectomy experiencing one or more osteoporotic fracture.