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ADT patients deviate from 'metabolic syndrome' profile
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MedWire News: The overall pattern of metabolic changes found in prostate cancer patients using androgen deprivation therapy (ADT) does not match the metabolic syndrome, US researchers say.
As seen in the metabolic syndrome, men using a gonadotrophin-releasing hormone (GnRH) agonist experienced an increase in fat mass and waist circumference, reduced insulin sensitivity, and an increase in serum triglycerides, reports the team from Massachusetts General Hospital in Boston.
However, unlike the metabolic syndrome, ADT use was also associated with an increase in subcutaneous fat, a decrease in high density lipoprotein (HDL) cholesterol and adiponectin, and GnRH agonist use was not associated with changes in waist-to-hip ratio, blood pressure, or C-reactive protein.
"Additional research is necessary to better characterize the metabolic effects of GnRH agonist treatment in men with prostate cancer and to understand the implications for cardiovascular disease risk," lead author Matthew Smith and co-workers say.
The team followed-up 26 prostate cancer patients using GnRH agonist for a year and assessed changes in the cardiovascular risk factors associated with the metabolic syndrome.
In the 12 months of the study, the men experienced a significant increase in their body mass index, weight, and waist circumference. Total abdominal fat increased by a significant 16.5%, mostly attributed to an increase in subcutaneous fat, with an overall average 11.2% increase in fat mass and 3.6% drop in lean body mass.
However, the men's blood pressure, C-reactive protein concentrations, and hip-to-waist ratios did not significantly alter during the study.
Furthermore, while serum triglycerides increased by 19.4%, in line with the metabolic syndrome, the men also experienced a significant 9.3% increase in HDL cholesterol and a 36.4% increase in serum adiponectin levels in the first 3 months of treatment. These rises were maintained throughout the remainder of the study and would not be expected in patients with the metabolic syndrome.
Recognizing that the metabolic syndrome is imprecisely defined and that patients using ADT have a distinct metabolic profile, the team concludes: "We recommend that clinicians evaluate and treat individual cardiovascular disease risk factors without regard for whether a prostate cancer survivor meets the criteria for diagnosis of metabolic syndrome."
They add: "Future research should focus on understanding the clinical implications of the distinct pattern of metabolic changes associated with GnRH agonist therapy in prostate cancer survivors."
Cancer 2008; 112: 2188-2194
http://www3.interscience.wiley.com/journal/117940805/abstract
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