Table 7.

Summary of recommendations to prevent side effects in older men on ADT.

Side effect	Screening	Prevention	Treatment
Hot flashes	Moyad screening tool	a	See Table 2 for various complementary or pharmacologic approaches for treatment
Anemia	Hemoglobin and hematocrit assessment prior to starting ADT and every 3–6 months	Assess and treat other known causes of anemia such as folate, vitamin B-12 or iron deficiency	Consider transfusion if severe anemia or symptomatic
Sexual side effects	Ask patient and partner about baseline sexual functioning	a	Sexual rehabilitation and counseling
			Oral phosphodiesterase inhibitors Mechanical therapies
Cognitive side effects	Ask patient about baseline memory issues	a	Refer to specialist if concern for cognitive decline
	Screen with validated cognitive scale such as Short Portable Mental Status Questionnaire or Mini-Mental Exam If memory problems or abnormality on screening tool, refer to specialist and for baseline neuropsychological testing Repeat screening and/or neuropsychological tests at yearly if memory symptoms worsen or if patient has baseline deficits prior to starting ADT
Psychological side effects	Ask patient about symptoms of depression prior to starting ADT and at each visit	a	Antidepressant
	Can use validated geriatric depression scales		Counseling
Metabolic syndrome and cardiovascular health	Assess history of coronary artery disease and diabetes	Inform other physicians including primary care about potential risk of worsening coronary artery disease and/or diabetes with ADT initiation	Close monitoring for progression of disease
	Assess risk factors for coronary artery disease and diabetes	Consider referral to cardiac specialist for those with underlying coronary artery disease	Treatment of underlying and worsening coronary artery disease and diabetes per guidelines and in concert with primary care and specialist
	May need to confer with primary care physician
Osteoporosis and fractures	Assess risk factors for osteoporosis	Calcium 1500 mg daily	Bisphosphonates
	Baseline and yearly bone mineral density scans	Vitamin D 600–800 IU daily	Resistance training
Physical function and falls	Ask about fall history at baseline and every visit	Resistance training	If history of falls, evaluate for assist device
	Assess performance with validated tool such as timed up and Go or Short Physical Performance Battery	Home safety evaluation	Refer to specialty falls clinic
			Refer to physical and occupational therapy

^aNo evidence-based data.