Gonadotropin releasing hormone (GnRH) agonists and the risks of diabetes and cardiovascular disease in men with prostate cancer

摘要

Androgen deprivation therapy (ADT) accomplished by either a gonadotropin releasing hormone (GnRH) agonist, GnRH antagonist, or bilateral orchiectomy is a common treatment for prostate cancer, the most common cancer in men. Given that most men diagnosed with prostate cancer will not die as a direct result of their prostate cancer, competing health risks are an important consideration. Several adverse metabolic effects of ADT have recently been described. The potential benefits of ADT in any given clinical setting must therefore be weighed against the potential harms. In October 2010, the United States Food and Drug Administration (FDA) released a safety announcement warning about increased risk of diabetes and cardiovascular disease due to GnRH agonist treatment, though these effects likely would result from any intervention that causes castrate testosterone levels. This commentary briefly summarizes the existing literature and provides perspective on its application to clinical practice. We advocate the adapted use of existing guidelines designed to manage the risks for diabetes and cardiovascular disease in the general population.