Multisystem Mechanisms of Fall Risk in Elderly Men Receiving Androgen Deprivation Therapy: A Clinical and Public Health Evaluation

Androgen deprivation therapy (ADT) is a mainline treatment for advanced prostate cancer, yet its systemic effects substantially elevate fall risk in elderly men. This paper examines the multifactorial mechanisms driving ADT-associated falls, including rapid-onset sarcopenia, neuromuscular dysfunction, cognitive impairment, and cardiovascular dysregulation. Testosterone suppression leads to loss of muscle mass, diminished motor coordination, and executive dysfunction. These factors collectively compromise gait stability and postural control. ADT also accelerates bone mineral loss, increasing susceptibility to fractures from low-energy falls. Neuroimaging studies reveal structural brain changes such as cerebellar atrophy and disrupted visuospatial processing that further impair balance. Despite growing awareness of these risks, fall prevention remains underemphasized in prostate cancer survivorship care. A widely publicized case involving an elderly public figure, whose frequent falls preceded the disclosure of advanced prostate cancer, illustrates the real-world consequences of functional decline associated with ADT. This paper advocates for a proactive and interdisciplinary survivorship model that incorporates resistance training, cognitive screening, orthostatic evaluation, and bone health monitoring to reduce fall risk and improve outcomes in men receiving ADT.