Ongoing ADT Monitoring and Treatment Adjustments in Prostate Cancer

This episode, titled “Ongoing ADT Monitoring and Treatment Adjustments in Prostate Cancer,” features multidisciplinary panelists discussing the following topics:

1. What do you include in your conversations about cardiovascular risk with patients when initiating androgen deprivation therapy (ADT) (eg, how does cardiovascular health influence whether ADT is appropriate or how to manage cardiovascular health)?
2. In patients receiving ADT-based therapy, share your monitoring schedule for cardiovascular risk in metastatic castration-sensitive prostate cancer (mCSPC).
   1. How do you monitor for other safety and tolerability concerns with ADTs in clinical practice?

3. In which clinical situations do you consider intermittent ADT for patients with advanced prostate cancer, and how does the ability to rapidly stop and recover testosterone influence your choice of ADT agent?

Led by the moderator, the panelists discuss practical approaches to monitoring patients on ADT over time, including whether urologists should more routinely consider cardiometabolic screening (lipids, A1C) and how best to coordinate these needs with primary care. Faculty describe a structured monitoring approach that includes early follow-up after ADT initiation, routine labs, symptom and quality-of-life check-ins, and longer-term considerations such as bone density assessment when therapy is expected to continue for extended durations. The panel also highlights the importance of tracking testosterone levels alongside prostate-specific antigen to identify testosterone “breakthroughs,” with discussion of potential causes such as adherence challenges with oral therapy or administration/technique issues with injectables. Finally, the group discusses intermittent therapy, emphasizing that although it is not standard in mCSPC, it may be considered for selected patients seeking breaks due to tolerability, and that oral ADT is particularly useful when rapid offset and testosterone recovery are desired.

In the next episode, “The Role of Pharmacy in Multidisciplinary Management of Oral ADT in Prostate Cancer,” the panel discusses how pharmacists contribute to safe and effective oral ADT management by addressing drug interactions, supporting adherence, and assisting with therapy selection. They also highlight practical strategies for incorporating pharmacy expertise even in resource-limited practice settings.