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In an interview published October 14, Cleveland Clinic oncologist Christopher Wee discussed managing side effects while treating metastatic castration-sensitive prostate cancer. He described continuous androgen deprivation therapy as the standard approach for metastatic disease, while stressing that treatment decisions should account for patients’ health, priorities and tolerance.
Cleveland Clinic oncologist Christopher Wee said clinicians treating metastatic castration-sensitive prostate cancer must weigh the benefits of therapy against its effects on daily life, in an interview published October 14 by MedPage Today. In the third episode of its “Beyond Diagnosis” series, Wee discussed androgen deprivation therapy (ADT), side effects and how patients’ health and priorities can shape treatment decisions.
Wee said many patients want to extend survival while maintaining quality of life. He described ADT as a major contributor to side effects in systemic treatment for this disease. Those effects can include hot flashes, fatigue, muscle and bone density loss, sexual dysfunction, mood changes and weight gain. He also mentioned a slight increase in heart attack risk. Wee said effects vary: many patients manage treatment without major disruption, while some have more difficult symptoms that are hard to predict.
He said clinicians can discuss trying a treatment and monitoring how a patient feels. Wee also pointed to the preventive purpose of therapy: treatment may delay problems from disease progression, including bone-related events, fractures or pain. Those possible benefits can be difficult to weigh against side effects when a patient feels well at the time treatment begins.
Wee discussed relugolix, an oral ADT option, alongside injectable treatments such as leuprolide. He said some patients value relugolix because it can be stopped without the same prolonged drug effect associated with an injection. He said testosterone may rebound after stopping and side effects may subside, but the interview did not provide patient-specific timelines or guarantees.
Balancing Disease Control and Daily Life
The discussion addresses a practical challenge for people starting treatment: side effects can appear before symptoms of cancer progression, while some benefits of treatment involve preventing future complications. That can make it harder to judge treatment by how a patient feels from day to day. Wee’s comments frame the decision as a conversation about survival goals, possible harms and personal priorities, rather than side effects alone.
His remarks also distinguish between managing side effects and changing the treatment plan. Wee described continuous ADT as the standard approach for metastatic disease, while acknowledging that a patient experiencing substantial difficulty may make an informed decision with a clinician after weighing risks and benefits. The interview does not offer individualized medical advice or establish that stopping treatment is safe for any particular patient.
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How ADT Fits Metastatic Care
The interview focuses on metastatic castration-sensitive prostate cancer, a setting in which the disease has spread and remains sensitive to treatments that lower or block testosterone. Wee described ADT as a central part of systemic treatment. He also referred to androgen receptor pathway inhibitors and chemotherapy as other treatment options discussed in care for the disease.
Wee said intermittent ADT is not the preferred approach for metastatic disease. He cited a trial comparing intermittent and continuous treatment in which researchers could not show that intermittent therapy was non-inferior. He said this is why continuous therapy remains the standard. The source does not provide the trial’s name, results in detail or the patient groups studied.
““Most patients’ top priority in treating this disease is to extend overall survival as long as possible while maintaining their quality of life.””
— Christopher Wee, Cleveland Clinic
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Individual Effects Remain Unpredictable
Wee said it is difficult to predict which patients will have more severe side effects. The interview does not quantify how often each effect occurs, explain how risk differs by patient, or provide detailed advice for preventing or treating specific symptoms. It also does not name the intermittent-treatment trial or give its full findings.
The source describes relugolix as an option some patients prefer, but it does not establish that the drug will produce fewer side effects for every patient or specify how quickly testosterone levels recover after stopping. Treatment changes, including any pause in ADT, require discussion with the treating oncology team. The interview presents continuous treatment as the default for metastatic disease.
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Ongoing Decisions With Care Teams
The episode is part of MedPage Today’s “Beyond Diagnosis” series on metastatic castration-sensitive prostate cancer. In practice, the next step for a patient concerned about side effects is to discuss symptoms, overall health and treatment priorities with the clinician managing care. The interview does not announce a new guideline, trial result or change to standard treatment.
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Key Questions
Which side effects of ADT did Wee discuss?
He listed hot flashes, fatigue, muscle loss, bone density loss, sexual dysfunction, mood changes and weight gain. He also mentioned a slight increase in heart attack risk.
Is intermittent ADT the standard for metastatic disease?
No. Wee said continuous ADT remains the standard approach. He cited a trial that did not establish intermittent treatment as non-inferior to continuous treatment.
What is relugolix?
Relugolix is an oral option for ADT. Wee said some patients value that it can be stopped without the prolonged drug effect associated with an injection. The interview does not give a guaranteed timeline for testosterone recovery or symptom relief.
Should a patient stop ADT if side effects become difficult?
The interview does not give that instruction. Wee said patients facing substantial difficulties can make informed decisions after weighing risks and benefits with their clinician. Patients should discuss symptoms and treatment concerns with their oncology team.
Source: rss
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