Men who undergo conventional hormone therapy treatments for prostate cancer could be setting themselves up for another potential health problem later on in life: renal failure. This was the shocking finding of a recent study published in the Journal of the American Medical Association (JAMA), which found that androgen deprivation therapy (ADT), which suppresses testosterone, may lead to a rapid reduction in kidney function, and thus induce kidney failure.
Researchers from McGill University in Canada came to this conclusion after studying the effects of ADT in more than 10,000 men diagnosed with non-metastatic prostate cancer. Though the treatment can sometimes help induce prostate cancer regression in some men, it may also cause a hypogonadal condition that can eventually develop into acute kidney injury (AKI). In a worst-case scenario, ADT can lead to full renal failure, which can ultimately lead to death.
Among the 10,250 men evaluated as part of the study, 232 cases of first-ever AKI admission were identified during post-treatment followup evaluations. Compared to men who had never received ADT, those who did were found to be up to 250 times more likely to develop AKI, a finding that the study's researchers later quantified as a "significant" association between AKI and ADT. From this, the team deduced that ADT directly affects the likelihood of developing AKI.
"To our knowledge, this is the first population-based study to investigate the association between the use of ADT and the risk of AKI in men with prostate cancer," wrote the authors about their findings. "In this study, the use of ADT was associated with an increased risk of AKI, with variations observed with certain types of ADTs. This association remained continuously elevated, with the highest odds ratio observed in the first year of treatment. Overall, these results remained consistent after conducting several sensitivity analyses."
ADT needs to be administered far more discriminately, say expertsThe testosterone-inhibiting effects of ADT can also lead to other serious health problems in men including psychological damage, blood disorders, erectile dysfunction, low energy and fatigue, diabetes, heart disease, bone loss, and even permanent endocrine imbalance. In other words, ADT is not something that cancer doctors should administer lightly, especially when prostate cancer symptoms are ambiguous.
"Our study does raise the concern that perhaps we should be more careful in prescribing androgen deprivation therapy in patients who do not have the clear indication of it," said Laurent Azoulay, one of the study's researchers. "It's all about the balance, finding the right population for which the benefits clearly outweigh the risks."
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