Adverse metabolic consequences of androgen deprivation therapy (ADT) on Asian patients with prostate cancer: Primary results from the real‐life experience of ADT in Asia (READT) study - Wong - The Prostate - Wiley Online Library
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Corresponding Author
Chris H. M. Wong
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
Correspondence Chris H. M. Wong
Email: cuhk.chriswong@gmail.com
Ning Xu MD
Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
Jasmine Lim PhD
Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
Kuo-kang Feng MD
Department of Urology, Hsin-Chu BioMedical Park Hospital, National Taiwan University Hospital, Taipei, Taiwan
Wayne K. W. Chan FCSHK
Department of Surgery, Division of Urology, Kwong Wah Hospital, Mongkok, Kowloon, Hong Kong
Marco T. Y. Chan FCSHK (Urol)
Department of Surgery, Division of Urology, Tuen Mun Hospital, Hong Kong, Hong Kong
Steven Ch Leung
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
Dong-ning Chen MD
Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
Yun-zhi Lin MD
Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
Peter K. F. Chiu FCSHK
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
Chi Hang Yee FCSHK
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
Jeremy Y. C. Teoh FCSHK
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
Chiu-yuen Huang MD
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
Wei-sien Yeoh FRCS (Urol)
Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
Teng-aik Ong FRCS (Urol)
Department of Surgery, Urology Unit, University of Malaya, Kuala Lumpur, Malaysia
Yong Wei MD
Department of Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
Chi-fai Ng FCSHK
Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
Department of Surgery, Division of Urology, Prince of Wales Hospital, Shatin, Hong Kong
First published: 20 March 2023
Abstract
Background
Androgen deprivation therapy (ADT) use in prostate cancer (PCa) has seen a rising trend. We investigated the relationship between ADT and adverse changes in metabolic parameters in an Asian population.
Methods
This is an international prospective multicenter single-arm cohort yielded from the real-life experience of ADT in Asia (READT) registry. Consecutive ADT-naïve patients diagnosed of PCa and started on ADT were prospectively recruited from 2016 and analyzed. Baseline patient characteristics, PCa disease status, and metabolic parameters were documented. Patients were followed up at 6-month interval for up to 5 years. Metabolic parameters including body weight, lipid profiles, and glycemic profiles were recorded and analyzed.
Results
589 patients were eligible for analysis. ADT was associated with adverse glycemic profiles, being notable at 6 months upon ADT initiation and persisted beyond 1 year. Comparing to baseline, fasting glucose level and hemoglobin A1c level increased by 4.8% (p < 0.001) and 2.7% (p < 0.001), respectively. Triglycerides level was also elevated by 16.1% at 6th month and by 20.6% at 12th month compared to baseline (p < 0.001). Mean body weight was 1.09 kg above baseline at 18th month (p < 0.001).
Conclusion
ADT was associated with adverse metabolic parameters in terms of glycemic profiles, lipid profiles, and body weight in the Asian population. These changes developed early in the treatment and can persist beyond the first year. Regular monitoring of the biochemical profiles during treatment is paramount in safeguarding the patients' metabolic health.
1 INTRODUCTION
Androgen deprivation therapy (ADT) has been the backbone of the treatment of prostate cancer since the 1940s.1 Apart from its role in metastatic and advanced disease, more recently, there is growing evidence of its benefits in high-risk localized disease.2 With growing indications, its adverse effects have also been constantly in spotlight of many investigators. Castration as the physiological basis of ADT3 has been shown to be associated with derangement of glucose and lipid metabolism, and subsequently a wide range of adverse events including cardiothrombotic disease, diabetes, metabolic syndrome, and osteoporosis.4-12 The effects could be significantly different between regions and ethnicities given the disease pattern and the different biochemical responses to ADT in Asians compared to Caucasians.13 Most of the currently available evidence is from the western Caucasian population and the Asian evidence basis appears to be less abundant and more heterogenous. Prospective evidence with an adequate sample size is even more lacking. There is still a need to bridge the knowledge gap and provide more information on the metabolic outcomes including the clinically relevant biochemical changes from ADT on Asian prostate cancer patients.
2 MATERIALS AND METHODS
The real-life experience of ADT in Asia (READT) registry (Clinical trials registration NCT03703778) is a prospective international multicenter observational cohort aiming at investigating outcomes of Asian patients receiving ADT. It recruits prospectively Asian patients diagnosed of prostate cancer and put on ADT. Consecutive Asian patients diagnosed with prostate cancer, who had been ADT-naïve and with ADT initiated since 2016 were recruited. Six centers in Hong Kong, China, Taiwan, and Malaysia participated in the recruitment process. Each participating center recorded baseline and follow-up data according to a standardized template. Patients were followed up at 6-month interval for changes in biochemical profiles and clinical condition. All patients from the database with follow-up data of up to 5 years of were retrieved. In the current study, we analyzed the data concerning metabolic changes after ADT initiation. At last, 589 registered patients were eligible for this current analysis.
The patients’ baseline characteristics at diagnosis were recorded. These included comorbidities, such as metabolic illnesses, and cardiovascular diseases. Prostate cancer status including tumor staging as described by the Union for International Cancer Control (UICC) latest edition, International Society of Urological Pathology (ISUP) grade group, and prostate-specific antigen (PSA) value were reported. Treatment status including types of ADT used and additional chemotherapeutic agents, such as older generation of antiandrogen, new androgen receptor pathway inhibitors, chemotherapy, and so on.
Hypertension, diabetes, and hyperlipidemia were defined if the patient had a diagnosis under the International Classificaiton of Disease coding system or if they had already been put on related medications. Metabolic changes across the duration of follow-up are investigated and documented. Parameters including body weight, cholesterol, triglyceride, fasting sugar, and hemoglobin A1c (HbA1c) were recorded. The level of triglycerides, fasting sugar, and HbA1c were log-transformed for the analysis of skewed data. Linear mixed models were used to investigate the changes over time. Baseline age, hypertension, diabetes, and hyperlipidemia status were included as fixed effects. Random intercepts were included to handle patient-specific and hospital-specific heterogeneities. The dependent variables are described as the estimated mean differences compared to baseline status. An autoregressive correlation structure between follow-up visits was assumed. Bonferroni correction was used to adjust for multiple testing across time. All statistical analyses were performed using SPSS software, version 27 (IBM). A two-sided p value of <0.05 was considered statistically significant.
3 RESULTS
A total of 589 patients were included in the analysis, with median follow-up time is 549 days (interquartile range [IQR]: 341–1060 days). Table 1 showed the baseline characteristics of the cohort. The median age of the patients was 72 (IQR: 67–78). A significant number of patients had pre-existing metabolic conditions. 25.6% patients had baseline diabetes, 57.7% had hypertension, and 28.5% had hyperlipidemia.
| Baseline characteristic | All patients, N = 589 (%) |
|---|---|
| Age (IQR) | 72 (67–78) |
| Hypertension | 340 (57.7) |
| Diabetes | 151 (25.6) |
| Hyperlipidemia | 168 (28.5) |
| Mean body mass index (±SD) | 24.5 (±11.6) |
| Coronary heart disease | 65 (11.0) |
| PSA level (ng/mL) (IQR) | 59.1 (19.6–186.9) |
| ISUP grade group | |
| 1 | 41 (7.0) |
| 2 | 56 (9.5) |
| 3 | 42 (7.1) |
| 4 | 130 (22.1) |
| 5 | 279 (47.4) |
| Unknown | 41 (7.0) |
| Metastasis at presentation | 297 (50.4) |
| Type of ADT | |
| Bilateral orchiectomy | 37 (6.3) |
| LHRH agonist | 401 (68.1) |
| Goserelin | 18 (4.5) |
| Leuprolide | 311 (77.6) |
| Triptorelin | 37 (9.2) |
| Zoladex | 35 (8.7) |
| LHRH antagonist (Degarelix) | 141 (23.9) |
| Additional treatment | |
| Antiandrogen | 125 (21.2) |
| Bicalutamide | 118 (94.4) |
| Cyproterone | 1 (0.8) |
| Flutamide | 5 (4.0) |
| Nilutamide | 1 (0.8) |
| Concomitant upfront chemotherapy | 57 (9.7) |
| Androgen receptor pathway inhibitors | 23 (3.9) |
| Intermittent usage | 13 (2.2) |
- Note: Continuous variables were presented as median (IQR), while categorical variables were presented as frequencies and percentages.
- Abbreviations: ADT, androgen deprivation therapy; IQR interquartile range; SD, standard deviation.
Regarding disease characteristics, the median PSA of our cohort was 59.1 (IQR: 19.6–186.9). A large portion of patients have an ISUP grade group of 5 (279 patients, 47.4%). 297 patients (50.4%) had metastatic disease at presentation. Concerning the initial modality of ADT, bilateral orchidectomy was performed on 37 patients (6.3%), luteinising hormone-releasing hormone (LHRH) agonist was given in 401 patients (68.1%), and 141 patients received LHRH antagonist (23.9%). Out of the patients who received agonist, leuprolide was the most commonly offered regimen (77.6%). 23 patients received concomitant novel androgen receptor pathway inhibitors and 57 patients had received concomitant chemotherapy within the 6 months of initiation of ADT.
The mean changes of fasting glucose and HbA1c level across time within this cohort of ADT users were depicted in Figure 1. Significant changes were observed as early as 6th month, with the mean fasting sugar being 4.8% above the baseline (p < 0.001). The difference further increased to being 6.6% above baseline (p < 0.001) at 24 months. The change in HbA1c also followed similar pattern with mean HbA1c level increased by 2.7% at 6 months (p < 0.001) and 4.1% at 24 months (p < 0.001), when compared to baseline. Body weight changes also had an increasing trend as early as 6 months which lasted till 24th month (Figure 2). Triglyceride level also had an increase of 16.1% at 6 months (p < 0.001) and 20.6% at 12th month (p < 0.001), which remained elevated in the later follow-ups when compared to baseline (Figure 3). Drop in the high-density-lipoprotein was observed from 12 months onward, although the differences did not reach a statistical significance. The changes in these metabolic parameters in terms of estimated mean differences across times were illustrated in Table 2.
Mean increase of fasting glucose and HbA1c (in %) across time after initiation of androgen deprivation therapy. [Color figure can be viewed at wileyonlinelibrary.com]
Mean increase of body weight (in kg) across time after initiation of androgen deprivation therapy. [Color figure can be viewed at wileyonlinelibrary.com]
| Metabolic parameters | Estimated mean difference (95% CI) | p Value |
|---|---|---|
| Fasting sugara | ||
| Time (baseline as reference) | ||
| Month 6 | 0.048 (0.024–0.073) | <0.001 |
| Month 12 | 0.055 (0.028–0.083) | <0.001 |
| Month 18 | 0.064 (0.031–0.096) | <0.001 |
| Month 24 | 0.066 (0.028–0.103) | <0.001 |
| Month 30 | 0.055 (0.016–0.094) | 0.001 |
| Month 36 | 0.059 (0.011–0.106) | 0.007 |
| HbA1ca | ||
| Time (baseline as reference) | ||
| Month 6 | 0.027 (0.014–0.041) | <0.001 |
| Month 12 | 0.032 (0.017–0.046) | <0.001 |
| Month 18 | 0.029 (0.012–0.046) | <0.001 |
| Month 24 | 0.041 (0.020–0.063) | <0.001 |
| Month 30 | 0.032 (0.013–0.052) | <0.001 |
| Month 36 | 0.041 (0.019–0.063) | <0.001 |
| Weight (kg) | ||
| Time (baseline as reference) | ||
| Month 6 | 0.726 (0.264–1.187) | <0.001 |
| Month 12 | 0.964 (0.419–1.508) | <0.001 |
| Month 18 | 1.087 (0.430–1.745) | <0.001 |
| Month 24 | 0.803 (0.087–1.519) | 0.019 |
| Month 30 | 0.481 (−0.375 to 1.337) | 0.817 |
| Month 36 | 0.151 (−0.803 to 1.106) | 1 |
| Total cholesterol (mmol/L) | ||
| Time (baseline as reference) | ||
| Month 6 | 0.338 (0.227–0.449) | <0.001 |
| Month 12 | 0.268 (0.144–0.392) | <0.001 |
| Month 18 | 0.164 (0.022–0.306) | 0.015 |
| Month 24 | 0.163 (−0.0002 to 0.327) | 0.050 |
| Month 30 | 0.071 (−0.117 to 0.259) | 1 |
| Month 36 | 0.008 (−0.207 to 0.223) | 1 |
| High-density lipoprotein (mmol/L) | ||
| Time (baseline as reference) | ||
| Month 6 | 0.035 (−0.006 to 0.077) | 0.140 |
| Month 12 | −0.007 (−0.050 to 0.037) | 1 |
| Month 18 | −0.013 (−0.061 to 0.036) | 1 |
| Month 24 | −0.004 (−0.058 to 0.050) | 1 |
| Month 30 | −0.030 (−0.093 to 0.033) | 1 |
| Month 36 | −0.021 (−0.089 to 0.047) | 1 |
| Triglyceridea | ||
| Time (baseline as reference) | ||
| Month 6 | 0.161 (0.104–0.217) | <0.001 |
| Month 12 | 0.206 (0.142–0.270) | <0.001 |
| Month 18 | 0.193 (0.125–0.261) | <0.001 |
| Month 24 | 0.176 (0.104–0.248) | <0.001 |
| Month 30 | 0.246 (0.158–0.334) | <0.001 |
| Month 36 | 0.149 (0.060–0.238) | <0.001 |
| Low-density lipoprotein (mmol/L) | ||
| Time (baseline as reference) | ||
| Month 6 | 0.080 (−0.022 to 0.181) | 0.229 |
| Month 12 | 0.093 (−0.017 to 0.202) | 0.154 |
| Month 18 | 0.002 (−0.121 to 0.124) | 1 |
| Month 24 | 0.038 (−0.107 to 0.183) | 1 |
| Month 30 | −0.111 (−0.269 to 0.048) | 0.390 |
| Month 36 | −0.124 (−0.319 to 0.071) | 0.551 |
- Abbreviations: ADT, androgen deprivation therapy; CI, confidence interval.
Mean increase of triglycerides (in %) across time after initiation of androgen deprivation therapy. [Color figure can be viewed at wileyonlinelibrary.com]
Cardiothrombotic diseases (including ischemic heart disease, cardiovascular ischemia, and arteriothrombotic diseases) were observed in 20 patients in our cohort (3.4%). Out of the 20 events, 11 were documented within the 1st year of treatment initiation.
4 DISCUSSION
In this multicentre prospective study, upon receiving ADT, Asian prostate cancer patients were noted to develop adverse quantifiable metabolic changes in terms of body weight, fasting glucose, HbA1c, and triglycerides level. The metabolic changes were observed as early as 6 months after the initiation of ADT and some changes in parameters can perpetuate beyond 24 months after treatment initiation.
Significant number of studies and meta-analyses have attempted to explore the relationship of ADT and adverse metabolic outcomes. While the relationship is supported at large, they were not homogenous and negative results were also reported. Most of the available literature are based on Caucasian literature and studies are less abundant in the Asian population. Asian patients are known to have biochemical differences compared to the Caucasian counterparts, leading to a different baseline metabolic risks profile and physiological responses to androgen deprivation.14, 15 This has warranted separate evidence and analyses. Yet Asian studies with an adequate sample size are constantly lacking. Mitsuzuka and colleagues prospectively evaluated a cohort of 218 Japanese patients receiving ADT with a follow-up time of up to 1 year and reported on an elevation of fasting blood sugar HbA1c level.16 Torimoto and colleagues reported no change to cholesterol levels within 1 year of ADT initiation but body weight increase was noted in their 39-patient cohort.17 Nishiyama and colleagues compared the baseline and the post-ADT-initiation 6-months body weight and fasting sugar in 49 Japanese patients and reported a positive correlation.18 A summary of literatures related is listed as Table 3.
| Study | Population/nature | Metabolic changes at 6 months | Metabolic changes at 12 months | Metabolic changes at 18 months | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Lipids | Glucose | Body weight | Lipids | Glucose | Body weight | Lipids | Glucose | Body weight | ||
| Cheung et al.,19 Australia | Prospective 34 patients Nonmetastatic |
Not mentioned | A1c −0.1 (1.7%) | BMI unchanged | Not mentioned | A1c −0.1 (1.7%) | BMI + 0.5 kg/m2 (1.8%) | Not covered | Not covered | Not covered |
| Mitsuzuka et al.,16 Japan | Prospective 177 patients locally advanced or metastatic |
Not mentioned | Not mentioned | Not mentioned | TC + 10.6% LDL + 14.3% |
FG + 3.9% HbA1C + 2.7% |
+2.9% | Not covered | Not covered | Not covered |
| Nishiyama et al.,18 Japan | Prospective 49 patients histologically proven, nonmetastatic |
Tg +0.12 mmol/L (7.6%) TC + 0.29 mmol/L (6.1%) |
FG + 0.2 mmol/L (3.5%) | +0.5 kg | Not mentioned | Not mentioned | Not mentioned | Not covered | Not covered | Not covered |
| Salvador et al.,20 Spain | Prospective 33 patients locally advanced or metastatic |
TC + 17 mg/dL (8.1%0 LDL + 16 mg/dL (12.1%) |
Not mentioned | Not mentioned | Unchanged | Not mentioned | Not mentioned | Not covered | Not covered | Not covered |
| Seible et al.,21 United States | Retrospective 118 patients Nonmetastatic |
Not mentioned | Not mentioned | Not mentioned | Not mentioned | Not mentioned | +1.3 kg (1.5%) | Not covered | Not covered | Not covered |
| Smith et al.,22 United States | Prospective 25 patients Nonmetastatic |
Not mentioned | Not mentioned | Not mentioned | LDL + 18 mg/dL (9.0%) +7 mg/dL (7.3%) TC |
Not mentioned | +2.3 kg (+2.8%) | Not covered | Not covered | Not covered |
| Timilshina et al.,23 Canada | Prospective 257 patients Nonmetastatic |
Not mentioned | Not mentioned | +1.66 kg | Not mentioned | Not mentioned | +1.38 kg | Not mentioned | Not mentioned | +2.08 kg |
| Torimoto et al.,17 Japan | Prospective 39 patients Locally advanced or metastatic |
Tg +32.9 mg/dL (24.3%) LDL + 7.8 mg/dL (6.6%) |
Not mentioned | +0.62 kg | Tg +19.1 mg/dL (14.1%) LDL + 17.6 mg/dL (14.8%) |
Not mentioned | +1.37 kg | Not covered | Not covered | Not covered |
- Abbreviations: ADT, androgen deprivation therapy; BMI, body mass index; FG, fating glucose; LDL, low-density lipoprotein; TC, total cholesterol; Tg, triglycerides.
The major findings in the current study include: (1) glycemic control is at risk in patients receiving ADT as evident from the rise in fasting glucose and HbA1c level early after treatment initiation and the effect perpetuates; (2) early weight gain is noted in Asian patients receiving ADT; and (3) lipid profiles are also impaired from early on after initiation of treatment.
Multiple studies have reported relationships between androgen deprivation—the biochemical basis of ADT—and the risk of diabetes. Previously our group of investigators compared a cohort of Asian prostate cancer patients receiving ADT versus another cohort that did not. We noted a higher rate of new-onset diabetes and increasing oral hypoglycemic agents or insulin needs within the ADT group.5 Other retrospective studies on population-based cancer registry and meta-analyses also demonstrated similar findings.22, 24 ADT-related hyperinsulinemia and insulin resistance offered a physiological explanation of the related changes. Here we demonstrated such change from a biochemical point of view, with significant elevation of HbA1c and fasting sugar level picked up at the 6-month follow-up, which continues on a rising trend till 24 months. The levels demonstrated here are in line with the previously available Asian literatures, with quoted mean difference of HbA1c level ranging from 2.7% to 5.69% at 12 months, and fasting sugar level ranging from 3.5% to 5.48%.16-18, 25
In the current study, up to 1.09 kg of mean weight gain was documented in our cohort of patients at 18 months after ADT was started, and the difference was statistically significant. Previous literatures have demonstrated more increase in subcutaneous fat compared to visceral fat mass in patients receiving ADT, compared to patients with metabolic syndromes who had more fat gain in the visceral compartment.16, 26, 27 The gain reported by the current study is within the range of quoted values of 0.6%–3.8% in literatures.16, 18, 21, 28 Most of these literatures only documented weight gain up to 1 year. One publication recorded weight gain that peaked at 24 months and decreased subsequently at 36 months.23 The reason for the later drop in body weight after 2 years was uncertain. It might be related to the worsening of the general health of patients during the disease course or other metabolic mechanisms. Nevertheless, our study is able to demonstrate that this weight gain could persist beyond 1 year.
Lipid alterations were also noticed early upon starting ADT in Asian patients. Previous literatures have demonstrated significant increase in cholesterol levels within as early as 3 or 6 months of ADT initiation.20, 22, 24, 29 The change in lipid profiles seems to be more short-lived, with our data set demonstrating a peaked increase of total cholesterol at 6 months and triglycerides at 12 months. When looking into the specific lipid profiles, however, studies that investigated on the effect of ADT on lipid profiles have reported conflicting results. Multiple studies have reported that ADT is associated with an increase in triglycerides level,30-33 and the result appeared to be consistent. Whereas for LDL triglycerides, existing literatures were however more heterogenous. Some studies reported on an increase on ADL,30, 34-36 but some suggested there was no statistically significant relationship37, 38 and some even suggested a decrease in LDL.20, 39 The current cohort suggested that ADT was associated with a significant increase in triglycerides. LDL increase was also observed up till 2 years upon ADT initiation, although statistical significance was not reached. One possible explanation could be the use of statin. It might come to the physicians' realization that this group of prostate cancer patients receiving ADT could be more prone to the development of adverse cardiovascular risk factors. Statin could have been initiated during the follow-up timeframe, under the indication of LDL rise or primary prophylaxis against cardiovascular events as depicted by Framingham risk calculations, resulting in a controlled LDL level in some patients. Anyhow, the overall results would still be highlighting the role of early intervention of lipid levels upon ADT initiation.
The limitations of the current study should be addressed. First, the patient population in the current cohort was heterogenous. Consecutive patients that were initiated on ADT were recruited, meaning they had a variable disease staging and background. Tumor stage and progression might cause different presentations and symptoms, hence differences in patients’ mobility, diet intake, or pattern of daily living, all of which might contribute to metabolic health. Second, the profile of the ADT treatments offered is also heterogeneous. During our analysis, attempts were made to perform subgroup analysis on the differential metabolic effects of each of type of ADT on metabolic changes, as well as the metabolic implications of other concomitant treatment like chemotherapy. Yet the fact that there were multiple forms of ADT in our cohort hence relatively small sample size of each type of ADT, and the coadministration or the switching of different forms of treatment during the follow-up timeframe, had made the results underpowered to be presented. Such information could possibly be only further investigated with dedicated trials in attempt to compare the differential outcomes of specific forms of ADT. However, overall these limitations are valid depiction of how ADT is offered in real-life situations and the clinical dilemma involved. Contrarily, the current study still has merits. With the prospective nature of the current study, we were able to illustrate the temporal sequence of ADT treatment and the adverse metabolic changes. Multiple metabolic parameters were being investigated. Predetermined template of outcomes collection allowed use to minimize center and investigator-related heterogeneities in the analysis process. A relatively sufficient sample size of patients presented by the current study, especially compared to available Asian data on the captioned subject, has made our findings relevant for the discussion.
5 CONCLUSION
The association of ADT with adverse metabolic parameters in terms of glycemic profiles, lipid profiles, and body weight in the Asian population was demonstrated in this by-far one of the largest prospectively maintained databases of the Asian population. Such changes were noted early in the treatment at 6 months and can persist beyond the first year. Regular monitoring of the biochemical profiles during treatment aside from oncological control should not be overlooked in clinicians' everyday practice.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
REFERENCES
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