Managing side effects

Side effects from treatment should be closely monitored to detect changes and reduce impact on patient's quality of life

Common side effects for specific treatments
Androgen deprivation therapy (ADT)1,2Fatigue, weight gain, loss of bone density, sexual dysfunction, hot flashes, and mood changes. There could also potentially be serious cardiovascular risks. The effects on bone health could increase fracture risks. There may be effects on metabolic health that could cause insulin resistance and diabetes. Loss of muscular mass could cause issues with balance and movement.
Androgen receptor pathway inhibitors (ARPIs)3-5Fatigue, arthralgia, hypertension, nausea, edema, hypokalemia, fluid retention, hot flashes, diarrhea, vomiting, URTI, cough, headache, adrenocortical insufficiency, hepatoxicity, seizures, back pain, decreased appetite, musculoskeletal pain, and ischemic heart disease.
Chemotherapies and immunotherapies6,7Fatigue, nausea and vomiting, loss of appetite, infusion-related reactions or injection site pain, and chills, joint pain, or muscle weakness.
Poly(ADP-ribose) polymerase inhibitors (PARPis)8Hematological toxicities such as anemia, thrombocytopenia, and neutropenia, which are more serious side effects. In addition, secondary malignancies such as myelodysplastic syndrome and acute myeloid leukemia are serious complications that could warrant discontinuation of treatment.
Radioligand therapy (RLT)9Urinary problems, kidney toxicity, fatigue, nausea, vomiting, dry mouth, and bone marrow suppression.

Side effect management and patient counseling

Educating patients on the various side effects that they can expect with their treatment helps them be prepared and more watchful of their symptoms. Patients may also need to be assessed prior to treatment initiation for any risks of certain complications, such as cardiometabolic events.

Symptoms may depend on where the cancer has spread and could generally include:

  • Tiredness
  • Malaise
  • Bone pain
  • Breathlessness
  • Problems urinating
  • Weight loss
  • Loss of appetite
  • Bowel problems
  • Sexual problems
  • Swelling

While treatments may help alleviate some symptoms, it’s important to counsel patients and provide medications or recommendations for persistent symptoms.

A male doctor speaking to his elderly male patient.
A male doctor speaking to his elderly male patient.
The Prostate Cancer 360 initiative brought together a team of experts who worked to identify ADT challenges and provide management recommendations. The team found that bone health, sexual health, psychological health, and cardiometabolic health were largely impacted by ADT. Below you can find mitigation strategies for these health domains from Prostate Cancer 360, along with strategies for other symptoms.10
SymptomsMitigation strategies
Bone problems10

Bisphosphonates to increase bone mass for those with bone metastases from PCa and osteoporosis prevention.

Bone health agents such as denosumab, zoledronic acid, and alendronate to increase bone mass in men at high risk for fracture and for osteoporosis and prevention of skeletal-related events from bone metastases.

Counsel on dental care and weight-bearing physical activity.

Counsel patients on ADT about calcium and vitamin D intake, smoking cessation, and physical activity such as resistance and high-impact training to reduce fracture risk.

Assess the patient’s fall risk and if they are safe to exercise.

Refer patient for exercise physiology.

Sexual problems10

Assess sexual health and explain importance of maintaining sexual function.

Perform baseline sexual health assessment that asks details about patient's sexual abilities, activities, satisfaction, and fertility plans.

Educate patients on side effects such as erectile dysfunction (ED), reduced sexual desire, and potential decrease in penile and testicular size.

Encourage patients to continue sexual activity and explain importance of intimacy and use of ED medications, bupropion, lubricants, sex toys, increase in communication and exploration with sexual partner(s), and sperm banking.

Patients should consider romantic relationship counseling.

Psychological health changes10

Provide counseling to assess the patient’s neuropsychiatric health and explain this risk of depression and anxiety.

Review potential changes in cognitive function and discuss importance of talking with primary care providers about changes in emotional well-being and cognitive function.

Recommend patient self-assessment with PHQ-9 or another validated tool.

Encourage patients to use a side effects worksheet or pain/symptom diary.

Cardiovascular changes10

Perform baseline cardiometabolic assessment that includes patient’s family history, blood pressure, eGFR, and glucose levels (fasting and nonfasting), and order a lipid panel.

Counsel patients on risks for cardiometabolic events such as blood glucose issues, increased LDL cholesterol, high blood pressure, diabetes, and other cardiovascular risk factors.

Encourage patients to maintain a healthy weight and practice daily well-balanced diet and exercise.

Take a stratified approach to cardiovascular risk mitigation depending on patient's risk factors.

Consider statins for primary prevention in patients receiving ADT, regardless of cardiometabolic risk.

PainPain medication, radiotherapy, bisphosphonates, surgery to support damaged bones, transcutaneous electrical nerve stimulation (TENS), and nerve blocks.
Urinary problemsAlpha blockers, catheters, transurethral resection of the prostate (TURP), pelvic floor therapy, and anti-cholinergics.

Monitoring for common physiological complications of aPC treatment 

It’s important to develop a monitoring strategy to track side effects and symptoms your patient experiences. Some methods include:  

Icon of a paper with a cross on it and a test tube.

Blood tests to detect anemia or abnormalities in blood cell counts, to evaluate liver and kidney function, and to detect changes in metabolic parameters such as blood glucose.10,11 

  • Important for treatments such as PARPi or chemotherapy which cause myelosuppression and for patients on ADT with metabolic impairment 
  • For example, patients on niraparib are recommended to get weekly blood tests in the first month to check their platelet counts 
Icon of a person going through an imaging machine.

Bone density scans for patients on ADT.10 

  • Regularly evaluate your patient’s bone health and provide necessary counseling 
  • This includes:
    • Calculating 10-year fracture risk with a country-specific Fracture Risk Assessment Tool (FRAX) algorithm 
    • Evaluating vitamin D status at baseline and annually 
    • DEXA scan within 1-6 months of starting ADT and every 1-3 years thereafter 
Icon of a heart with monitoring heartbeat on top.

Monitoring blood pressure, cholesterol levels, and other heart health markers should be regularly performed to assess cardiovascular risks.10

  • Routinely check blood pressure, eGFR, glucose levels, and order a lipid panel 
  • Consider performing a 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment
  • Coronary artery calcium scanning can be considered for patients reluctant to initiate statin therapy 
gray-icoon

Learn more about ways to monitor for and mitigate common treatment side effects of ADT at ProstateCancer360.com and help your patients build healthier habits while on ADT at IncreMENtalADT.com

Mitigation Strategies

Mitigation Strategies

Download a printable quick-reference guide about side effect mitigation strategies for your advanced prostate cancer patients that you can use in-office.
DOWNLOAD PDF

Maintaining patient quality of life is critical during aPC treatment

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