Hormonal therapy for prostate cancer eventually produces decreases in libido and potency in virtually all patients regardless of the modality used.34,124 Additional side effects include lethargy, depression, anorexia, breast swelling with or without tenderness, hot flashes, anemia, and osteoporosis with potential for pathological fracture.14,125-130 Most side effects, including impotence and infertility, are slowly reversible with cessation of therapy. However, reduced bone mineral density often does not reverse after prolonged hormonal suppression. There is a consensus that irreversible changes occur more often after suppression of longer than 18-24 months.
When different agents are compared, castration and cyproterone acetate are tolerated better than estrogens. Castration or cyproterone ac etate produces less gynecomastia, diarrhea, nausea, and liver function abnormality than flu-tamide; but cyproterone is associated with a higher incidence of thrombotic problems.131 Hot flashes are more common with castration than flutamide or biclutamide alone.45
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