Androgen Deprivation Therapy and the Heart: What Prostate Cancer Survivors Should Monitor

What ADT changes

Lowering testosterone increases fat mass and reduces lean muscle, raises insulin resistance, alters lipids, and contributes to rising blood pressure. Bone density falls in parallel. These are metabolic effects of the therapy rather than lifestyle drift, though activity and diet still influence how far they go.

Fatigue and hot flushes reduce activity at exactly the moment activity would help most, which compounds the metabolic picture.

Who should be reviewed first

Men with known coronary disease, prior myocardial infarction, heart failure, significant arrhythmia, or poorly controlled diabetes or hypertension gain most from a cardiology opinion at the point of starting therapy. The purpose is to optimise existing treatment, not to withhold cancer therapy.

For everyone else, a documented baseline of blood pressure, lipids, HbA1c, weight, and waist measurement gives the reference point that later monitoring needs.

Monitoring during therapy

Blood pressure, lipids, and HbA1c on an agreed interval, with weight tracked between times, catch most of the drift while it is still easy to address. Bone density monitoring runs alongside on the schedule your team sets.

New chest tightness, breathlessness on exertion, or ankle swelling should be assessed rather than attributed to therapy fatigue.

What helps most

Resistance exercise two or three times weekly counters muscle loss, insulin resistance, and bone loss simultaneously, and it is the single highest-value intervention here. Aerobic activity adds blood pressure and lipid benefit. Where lipids or glucose cross treatment thresholds, medication should be started rather than deferred on the grounds that the cause is the therapy.