Opinion
Video
An expert’s view on combination ARPI/ADT and long-term toxicity in prostate cancer
Author(s):
“The impact on bone health is really significant with long-term androgen suppression," says Dr Louise Kostos.
In a recent study of combination therapies for the treatment of locally advanced and metastatic hormone-sensitive prostate cancer, investigators acknowledged although combination treatment regimens appear to improve survival, they can also result in long-term toxicity.1
In an interview with Urology Times®, study author Dr Louise Kostos said, “Most of the landmark ADT [androgen deprivation therapy] and ARPI [androgen receptor pathway inhibitor] trials have published quality of life analyzes, and pleasingly, they found that the addition of an ARPI to ADT, compared to ADT alone, didn't seem to reduce patients’ quality of life. It was maintained, so it doesn't seem that patients are necessarily having a worse quality of life with the combination treatment; it's more that because of the increased effectiveness, they're on treatment for much longer, so they're therefore more exposed to this long-term toxicity, and a lot of that relates to the androgen suppression.” Kostos is a medical oncologist and PhD candidate at Peter MacCallum Cancer Centre in Victoria, Australia.
In the interview, Kostos explained what should be monitored in these patients.
“I think that the big issues that really need close monitoring from the outset are the fact that being on ADT increases your risk of metabolic syndrome and cardiovascular disease. These patients really need regular monitoring of their lipid profile and their HbA1c and should be encouraged to make lifestyle modifications to reduce their cardiovascular risk and commence a statin as needed to try and mitigate their risk,” Kostos said.
She also touched on monitoring bone health.
“The impact on bone health is really significant with long-term androgen suppression, increasing the risk of osteoporosis. All patients really should get a baseline bone mineral density scan and make sure they have adequate vitamin D and calcium supplementation, and if they do have established osteopenia or osteoporosis, then have treatment for that,” Kostos said.
REFERENCE
1. Azad AA, Kostos L, Agarwal N, et al. Combination therapies in locally advanced and metastatic hormone-sensitive prostate cancer. Eur Urol. 2025 Feb 12:S0302-2838(25)00023-5. doi:10.1016/j.eururo.2025.01.010
