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Managing treatment side effects through lifestyle changes: Empowering patients to take control

Francesco Montorsi

Montorsi senza slides-HD

Androgen deprivation therapy has both short-term and long-term side-effects due to the suppression of testosterone. These adverse effects not only have a negative impact on quality of life but also can lead to serious complications. Exercise is crucial, and diet, smoking cessation, and decreasing alcohol intake are key factors in reducing the risk of complications and improving quality of life.


Managing treatment side effects through lifestyle changes: Empowering patients to take control - Francesco Montorsi

Managing treatment side effects through lifestyle changes: Empowering patients to take control - Francesco Montorsi

Now for my last short talk which deals with what we can do to treat our patients better. I would like to challenge that the colleagues and the friends who clapped their hands when I said the patient 76 years old I would have taken out the prostate, so I understand, I sense that we think the same way. What I would like to add to this is the knife is not the only thing we have to treat our patients in the best possible way and we should really do our best to treat the patients from all the perspectives. I am happy to share these slides with you; you will immediately understand what I mean.

Short term side effects of ADT

There are side effects of androgen deprivation therapy which can be both short term – you have heard about this, and also long term. These are very well-known. Perhaps we tend to forget these in our everyday practice, probably because we are so much concentrating on surgery, but essentially also we should not forget that there are a number of things that our patients can do just to feel better. This type of behaviour has a significant positive effect on the whole body – quality of life.

Lifestyle changes to manage ADT side effects

The lifestyle changes that can be supported to manage the side effects or hormones are depicted here in these slides and we all know these from the time we were still at medical school, so it is nothing new, nothing strange.

Effects of exercise on ADT side effects in PCa

There is an abundance of literature suggesting that there is an effect of exercise on the side effects of androgen deprivation therapy. Look at all the good things that regular physical exercise can do in our patients. Those bullet points are all of extreme interest for our patients. We know this so I think we should really remember that talking to our patients, asking help to our cardiologist friends can create a lot of improvement.

Counselling and education

Counselling and education is important. We cannot spend only five minutes with every one of our patients telling them “Let’s imagine we have done a radical prostatectomy, now the patient is on androgen deprivation therapy, your skin incision is fine, you can do whatever you want. I’ll see you in six months”. That is not enough. We should really talk to them and help them in improving their lifestyle.

FEEL+ Programme

Bertrand Tombal had a very good thought when he imagined his new FEEL+ programme, which is an educational, patient oriented and holistic tool to improve health and wellbeing during ADT. He did not discover anything significantly new, but being a clever man he used his knowledge in medicine to highlight a few easy things that if we remember at all times can improve the life of our patients significantly.

FEEL+ Programme:

Essentially in this programme, which is now being studied in a prospective fashion, he is essentially talking about physical exercise – get moving, eat well, which is different from stop eating, especially in Italy – that would be very much appreciated.

FEEL+ physical exercise programme

He developed his JAMES exercise programme, which means jog or walk, abdominal, muscle building exercises and suppleness, which I think makes a lot of sense and it is a very cool concept. Jogging or walking, abdominal stomach exercise, muscular exercises, so weight training.

FEEL+ healthy diet plan

Then learn to eat in a different way with the following concepts that are very easy to understand and that can be shared by ourselves, with our patients and this, indeed, can make a very significant difference.


When talking about diet, which is not stop eating, smoking cessation, reduction of alcohol intake, so this can altogether, liaised with exercise, can change things in our patients. Then the cardiologist is there to help, the diabetologist is there to help, but indeed ourselves, being a urologist, a radiation oncologist, a medical oncologist, we can start already helping our patients very much.

Keypad question

My last slide before the questions that we would be happy to entertain, we still have a few minutes, is for you and asking if you are using these types of ideas? Can I see a show of hands? How many of you are telling your patients that they should exercise, they should eat in a better way and do all these things that I have shown you. Who is doing that positive? Raise your hands.

A good number. For those who have not yet started doing so, it is the time to move on.

Summary and conclusions

To conclude what we have told together and then again we will be happy to take questions if there are any, I think that we have clearly stated today that it is important to follow personalised treatment strategies, that when you see a patient with high burden disease you should consider androgen deprivation therapy with a fast onset of action. You now know that adding chemotherapy maybe something of importance in some of these patients. If you think about radiation therapy, the use before and after radiation of androgen deprivation therapy may play a significant role. This is true in some settings, with patients you want to operate upon, considering androgen deprivation therapy following the operation.

Consider the holistic approach which is important. For patients who have high cardiovascular risk factors and they do have also prostate cancer, we look forward to seeing the results of the PRONOUNCE trial, however, there are already signals which are suggesting that if you use an antagonist then you will harm less the heart and that is important to know.

Clearly the importance of a multidisciplinary team is right here, it is clearly more evident if we really have in front of us a difficult patient. Patient education plays a role.

We do have a number of take-home messages which are important from this session.