From the Guidelines
Androgen deprivation therapy (ADT) is associated with an increased risk of arthralgia, which can negatively impact quality of life in patients with prostate cancer. To manage arthralgia in patients undergoing ADT, the following strategies can be employed:
- Use non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800 mg every 6-8 hours) or naproxen (250-500 mg twice daily) for pain relief, as recommended by recent guidelines 1.
- Consider acetaminophen (500-1000 mg every 4-6 hours, not exceeding 4000 mg/day) as an alternative if NSAIDs are contraindicated.
- Engage in regular, low-impact exercise such as swimming or cycling for 30 minutes, 3-5 times per week to maintain joint flexibility and muscle strength.
- Apply heat or cold therapy to affected joints for 15-20 minutes, several times a day.
- Maintain a healthy weight to reduce stress on joints.
- Consider glucosamine and chondroitin supplements (1500 mg glucosamine and 1200 mg chondroitin daily), which may help with joint health.
- In severe cases, consult with your oncologist about temporarily reducing ADT dose or frequency, if possible without compromising cancer treatment, as suggested by recent studies 1. Arthralgia occurs because ADT reduces testosterone levels, which can lead to decreased bone density and muscle mass, putting more stress on joints. Additionally, estrogen levels may increase relatively, potentially causing fluid retention and joint inflammation. Managing these side effects is crucial for maintaining quality of life during prostate cancer treatment. According to a recent study 1, ADT is associated with significant morbidity, including osteoporosis and increased incidence of clinical fractures, highlighting the need for effective management of arthralgia in patients undergoing ADT.
From the FDA Drug Label
The most common (per patient incidence ≥ 10%) adverse reactions reported with Prolia in patients with bone loss receiving androgen deprivation therapy for prostate cancer or adjuvant aromatase inhibitor therapy for breast cancer are arthralgia and back pain. Adverse reactions reported in ≥ 10% of Prolia-treated patients receiving ADT for prostate cancer or adjuvant AI therapy for breast cancer, and more frequently than in the placebo-treated patients were: arthralgia (13. 0% placebo vs. 14.3% Prolia)
Arthralgia is a common adverse reaction in patients with bone loss receiving androgen deprivation therapy (ADT) for prostate cancer, with an incidence of 14.3% in Prolia-treated patients compared to 13.0% in placebo-treated patients 2.
From the Research
Relationship between Arthralgia and Androgen Deprivation Therapy (ADT)
- The studies provided do not directly address the relationship between arthralgia and ADT 3, 4, 5, 6, 7.
- However, some studies mention the adverse effects of ADT on bone health, including osteoporosis and increased risk of fracture 3, 6.
- One study found that ADT is associated with worsening of depression scores and quality of life, but not with changes in clinical pain or pain sensitivity 7.
- Another study mentions that patients receiving ADT must be well informed about the potential benefits as well as the risks of the treatment, including undesirable effects on muscle and bone health 3.
- There is no direct evidence in the provided studies to support a specific relationship between arthralgia and ADT.
Adverse Effects of ADT
- ADT is associated with a variety of adverse effects, including obesity, metabolic syndrome, osteoporosis, sarcopenia, diabetes mellitus, cardiovascular disease, gynecomastia, and sexual dysfunction 3.
- Patients and their partners are often poorly informed about the side effects of ADT, which can negatively impact their quality of life 5.
- Educational programs have been shown to be effective in improving patients' self-efficacy to manage ADT side effects and reducing side effect bother 4.