Commonly prescribed drugs for prostate cancer may significantly increase the risk of obesity, diabetes, high blood pressure, and heart problems, according to a major study published in the journal JAMA Oncology. Prostate cancer is the most common cancer in the UK, with approximately 64,000 new cases diagnosed annually.
Standard treatment for many prostate cancers involves androgen deprivation therapy (ADT), which reduces the body's production of testosterone. This is crucial as many prostate cancers rely on testosterone to grow. Increasingly, androgen receptor pathway inhibitors (ARPIs) are prescribed alongside ADT, particularly for advanced stages of the disease, to block cancer cells from utilizing any remaining testosterone.
However, researchers from the Sidney Kimmel Comprehensive Cancer Center in Pennsylvania have raised concerns about the potential side effects of these combined therapies. Analyzing the health data of 16,924 men with prostate cancer who received both treatments, the study found that nearly 40% developed metabolic syndrome within the first year of starting concurrent therapy.
Metabolic syndrome is a cluster of conditions including high blood pressure, high blood sugar, excess abdominal fat, and abnormal blood cholesterol levels. It significantly elevates a person's risk of developing type 2 diabetes and stroke, and is also associated with an increased risk of heart disease and premature death. The study noted that the majority of patients began showing symptoms of metabolic syndrome just one month after commencing the combined treatment.
High blood pressure, or hypertension, was the most frequent health complaint across all age groups studied. Insulin resistance and high cholesterol, which can contribute to narrowed arteries and increase the risk of heart disease and stroke, were also common, especially among older men aged 70 to 79. Researchers believe these adverse effects may stem from how effectively the therapies suppress testosterone, a hormone that plays a role in regulating body fat, blood sugar, cholesterol, and blood vessel function. Over time, reduced testosterone levels could make some patients more susceptible to weight gain, high blood pressure, and diabetes.
The study's authors emphasized the need for proactive, multidisciplinary approaches. They recommend integrating preventive cardiology and nutrition services into prostate cancer care pathways to help patients benefit from life-saving treatments while potentially mitigating long-term metabolic complications.
While the majority of prostate cancer patients undergo surgery or radiotherapy, ARPIs are used in approximately 15% of cases, often alongside hormone therapy. These drugs, such as apalutamide, enzalutamide, or darolutamide, are increasingly becoming part of first-line treatment for men with metastatic cancer, despite potential side effects. These potential harms are a factor in why the UK National Screening Committee recently advised against widespread screening for all men.