In a recent episode of MedPage Today's "Beyond Diagnosis" series, Cleveland Clinic oncologist Christopher Wee discussed how clinicians help patients with metastatic castration-sensitive prostate cancer balance treatment efficacy with quality of life. He noted that most patients prioritize extending survival while maintaining their daily functioning, and that side effects from newer oral therapies often resolve if treatment is stopped.
Wee explained that androgen deprivation therapy (ADT) is responsible for the majority of side effects, including hot flashes, fatigue, muscle loss, bone density loss, sexual dysfunction, and mood swings. While most patients tolerate these effects, some experience more severe toxicity that is hard to predict. He emphasized that preventing future complications, such as fractures or pain from disease progression, is an important but sometimes overlooked benefit of staying on treatment.
For patients concerned about being "stuck" with side effects, Wee highlighted relugolix, an oral agent introduced in recent years. Unlike traditional GnRH agonist injections, relugolix allows testosterone suppression to turn on and off more quickly, giving patients a sense of control. However, he stressed that for metastatic disease, continuous therapy remains the standard of care, as trials have not shown intermittent ADT to be non-inferior.