Management of hormonal treatment effects

Androgen ablation is an effective palliative treatment of advanced carcinoma of the prostate. A variety of drugs with diverse mechanisms of action, effectiveness, and side effects are used to treat patients with this disease. This paper discusses the management of the most common side effects that result from treatment with luteinizing hormone-releasing hormone (LHRH) agonists, antiandrogens, ketoconazole, estrogens, and progestational agents. The most common side effects are loss of libido and impotence, hot flushes, gynecomastia, the “flare” phenomenon (LHRH agonists), nausea and vomiting, liver toxicity, and thromboembolic events (estrogens). The flare phenomenon associated with LHRH analog treatment is prevented best by pretreatment with antiandrogens or estrogens. Progestational agents can reduce hot flashes markedly. Gynecomastia may be prevented by preliminary breast irradiation. Erectile dysfunction is the most problematic side effect and possible treatments for this condition are discussed. Cancer 1995;75:1983–6.