Common drug treatments for prostate cancer may substantially increase the risk of obesity, diabetes, and heart problems in patients, according to a significant study published in JAMA Oncology. Prostate cancer is currently the most prevalent cancer in the UK, with approximately 64,000 new diagnoses annually.
Standard treatment for prostate cancer often involves androgen deprivation therapy (ADT), which reduces the body's production of testosterone. Many prostate cancers depend on testosterone to grow, and limiting this supply can help slow or shrink tumors. Increasingly, androgen receptor pathway inhibitors (ARPIs) are being prescribed in conjunction with ADT, particularly for men with advanced disease. These drugs work by blocking cancer cells' ability to use any remaining testosterone, thereby enhancing treatment effectiveness.
However, researchers from the Sidney Kimmel Comprehensive Cancer Center in Pennsylvania have cautioned that these medications may elevate the risk of obesity, diabetes, and high blood pressure in patients, especially older men. These conditions, in turn, can lead to a notably higher risk of heart disease, liver disease, osteoarthritis, and other cancers. The study emphasizes the necessity of quantifying early metabolic risks as these drugs are used more frequently earlier in the disease course.
The research analyzed the health data of 16,924 men with prostate cancer who received both ADT and ARPIs but were otherwise healthy. The findings revealed that nearly 40 percent of these men developed metabolic syndrome within the first year of starting the combined therapy. Metabolic syndrome is a cluster of conditions, including high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels, which increases the risk of developing type 2 diabetes and stroke. It is also associated with a greater risk of heart problems and premature death, diagnosed when a patient has three or more of these risk factors.
The study indicated that most patients began showing symptoms of metabolic syndrome as early as one month after commencing the dual therapy. Hypertension was the most frequent complaint across all age groups. Insulin resistance and high cholesterol, which can narrow arteries and heighten the risk of heart disease and stroke, were also common, particularly among older men aged 70 to 79.
Experts suggest that these therapies might increase the risk of metabolic syndrome due to their effectiveness in restricting testosterone, a hormone that plays a role in regulating body fat, blood sugar, cholesterol, and blood vessel function. Over time, reduced testosterone levels may make some patients more susceptible to weight gain, high blood pressure, and diabetes, all contributors to metabolic syndrome.
The study's authors concluded that these findings necessitate proactive, multidisciplinary strategies. They recommend integrating preventive cardiology and nutrition services into prostate cancer care pathways to ensure patients benefit from proven survival advantages while potentially mitigating long-term metabolic complications.
While surgery and radiotherapy are common primary treatments for prostate cancer, hormone therapy is often initiated before, during, and sometimes after radiotherapy, depending on the cancer's aggressiveness. Approximately 15 percent of men diagnosed with the disease receive ARPIs, such as apalutamide, enzalutamide, or darolutamide, alongside standard treatment. These drugs are not routinely offered to all prostate cancer patients due to potential side effects but have become increasingly common in first-line treatment for men whose cancer has spread.