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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Treatment guide: Monitoring

Reducing ADT risks

Guide 14. Health care for ADT risks

Health risk

What are the options?


• Calcium and vitamin D3 if older than 50 years

• Denosumab, zoledronic acid, or alendronate if at high risk for

bone fracture


• Follow guidelines for general population

Heart (cardiovascular) disease

• Follow guidelines for general population

Reducing ADT risks

Guide 14

lists some risks of ADT and ways

to reduce them. One known risk of ADT is the

thinning and weakening of bones (osteoporosis).

Calcium and vitamin D3 taken every day may help

prevent or control osteoporosis. Both are advised if

you are older than 50 years old. Your blood should

be tested to ensure the proper levels.

If you are at high risk for bone fracture, there are

drugs that may strengthen your bones. Before

treatment, you should receive a DEXA (








bsorptiometry) scan to measure

your bone density. Denosumab, zoledronic acid,

or alendronate are recommended. Denosumab is

injected under the skin. Zoledronic acid is injected

into a vein. Alendronate is a pill that is swallowed.

One year after treatment has started, another

DEXA scan is recommended.

Denosumab, zoledronic acid, and alendronate

have possible side effects. They have been

linked to osteonecrosis—bone tissue death—of

the jaw. Other side effects are hypocalcemia

and arthralgias. You may be at higher risk of jaw

osteonecrosis if you already have dental problems.

Thus, it’s important to get a dental exam and

dental treatment before starting any of these


Diabetes and cardiovascular disease are common

in older men. ADT increases the risk for these

diseases. Thus, screening and treatment to reduce

your risk for these diseases are advised.

ADT and other hormone therapies will increase

your risk for other health conditions as discussed

in Part 4. These risks included erectile dysfunction,

fatigue, hot flashes, breast tenderness and growth,

diarrhea, weight gain, liver injury, and so forth.

There are ways to prevent or treat many of these

side effects. Examples include exercise for fatigue,

antidepressant drugs for hot flashes, and radiation

to prevent breast growth. Talk to your treatment

team about ways to manage risks of hormone