The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Screening for metabolic adverse effects in men with prostate cancer treated with androgen deprivation therapy in a large Melbourne hospital network (#251)

Alice Minchin 1 , Elisabeth Ng 2 , Ania Sliwinski 3 , James G Huang 3 , Helen O'Connell 3 4 , P. Shane Hamblin 2 5
  1. Department of Medicine, Western Health, Melbourne, Victoria, Australia
  2. Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia
  3. Department of Urology, Western Health, Melbourne, Victoria, Australia
  4. Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
  5. Department of Medicine, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia

Introduction
Androgen Deprivation Therapy (ADT) has an established role in the management of prostate cancer but is associated with multiple adverse metabolic effects [1]. Despite availability of national guidelines for management [2] the metabolic consequences of ADT may be overlooked in the time-poor public outpatient setting where the focus tends to be on cancer control.

Aim
To determine whether metabolic side-effect screening of ADT patients in our health service is in accordance with current practice guidelines.

Method
A retrospective audit (January 2016-September 2017) was undertaken of 104 patients treated with ADT at Western Health, Melbourne. Relevant medical records were identified through International Classification of Diseases version 10 Australian Modification coding. Data were collected to assess prevalence of testing for bone mineral density (BMD), blood pressure, BMI, lipids and glycaemic control at any time prior to or after initiating ADT.  We reviewed use of pharmacological treatment of bone, metabolic, and cardiac conditions, and referrals made to endocrine specialist clinics after ADT commencement. These data were compared to current guidelines [2].

Results
Prior to or during administration of ADT, 71% of patients were receiving pharmacotherapy for bone, cardiovascular or metabolic disease.  39% were receiving bone-related therapy (one or more of calcium, cholecalciferol, anti-resorptives), but only 8% had documentation of BMD screening. Screening for metabolic syndrome was variable; blood pressure was documented in 73% and BMI in 79%. Lipid profiles were documented in 24% and glucose levels in 32%. Referrals for Endocrinology input were infrequently performed, with referrals to the Diabetes Clinic in 2%, Endocrinology Clinic 4%, and Metabolic Bone Clinic 5%.  

Conclusion
When compared to national guidelines, significant deficiencies were apparent in screening for the metabolic consequences of ADT within our health service. Multi-disciplinary patient-centred care is essential to improve patient outcomes beyond oncological control, and minimise harm from the metabolic consequences of ADT.

  1. Rhee H, Gunter J, Heathcote P, et al. Adverse effects of androgen-deprivation therapy in prostate cancer and their management. BJU Int. 2015;115(Suppl 5):3-13.
  2. Grossmann M, Hamilton E, Gilfillan C, et al. Bone and metabolic health in patients with non-metastatic prostate cancer who are receiving androgen deprivation therapy. Med J Aust. 2011;194:301–6.