Most of us on ADT have experienced some weight gain and loss of muscle mass. Those are two conspicuous features of what is called metabolic syndrome (MetS). MetS is defined by a suite of features that include not just those two conspicuous features, but also a shift in blood markers related to lipids, cholesterol, and the risk of diabetes. One doesn’t need to have all of the features of MetS to be considered at risk of developing MetS. As PCa patients, we are warned that ADT carries a risk of MetS and that one should maintain a healthy lifestyle (exercise and diet) to minimize the risk.
Against that background, there’s a new paper out that does a meta-analysis of previous studies on ADT and comes up with a surprising result. There the author reports that “ADT was not associated with the development of MetS”.
One needs to remind themselves that it is not MetS per se that is the issue, but rather it is indicative of elevated risk for certain serious cardiovascular diseases such as hypertension and diabetes. In that regard, the paper concluded that men have a 25% increased risk of developing diabetes and a 30% increased risk of developing hypertension while on ADT. That’s serious stuff.
How could this paper find that the patients on ADT are less likely to develop MetS, yet still are at increased risk of hypertension and diabetes? It seems like a contradiction.
When one digs into the paper, a few factors show up that can account for this.
For example, the authors note that for some studies included in their analysis, it wasn’t clear what form of ADT the patients were on. Secondly, the studies were done from around the world. One needs to remind themselves that MetS is not one thing, but a suite of things…and one doesn’t have to present with all of them to be classified as having MetS. So, for example, for one population, weight gain may be the most common sign of MetS and in another , a shift in triglycerides may be more prominent. The authors didn’t document that specifically, but the studies included in the meta-analysis were from around the world and the authors acknowledged the high variability in their data, which may account for why they found less evidence of MetS.
Of course, that isn’t what really matters. It’s the long-term risks of the serious stuff like hypertension and diabetes that we need to be concerned about. In this regard, the authors are firm on their recommendations and we endorse them. Men starting on ADT need to be assessed for cardiac function and diabetic risk.
In addition, along with getting regular PSA tests, men should also get their haemoglobin A1c checked as a blood marker for diabetes, a cardiac assessment, and track their blood markers for MetS (triglycerides and cholesterol).
It isn’t the MetS that you need to worry about. It’s the cardiovascular and metabolic risks that need to be monitored, on any form of ADT.
Reference:
Swaby J, Aggarwal A, Batra A, Jain A, Seth L, Stabellini N, Bittencourt MS, Leong D, Klaassen Z, Barata P, Sayegh N, Agarwal N, Terris M, Guha A. Association of Androgen Deprivation Therapy with Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis. Clin Genitourin Cancer. 2022 Dec 26:S1558-7673(22)00264-6. doi: 10.1016/j.clgc.2022.12.006. Epub ahead of print. PMID: 36621463.