**7. Androgen deprivation therapy (ADT)**

Pharmacological castration with GnRH agonists is the standard treatment for patients with locally advanced or metastatic Pca. However, it is burdened with several adverse effects like osteoporosis, loss of libido, erectile dysfunction and finally metabolic syndrome. Increased levels of total cholesterol, LDL and decreased HDL, diabetes and hypertension contribute to higher risk of acute coronary syndrome (ACS).

Obese patients receiving ADT are at highest risk for developing ACS as ADT therapy and obesity shares the cardiovascular risk through the metabolic syndrome. They should be constantly monitored and treated accordingly (Cleffi et al., 2011). Osteoporosis in Pca is not only the result of cancer itself. Osteoblastic metastases of prostate cancer contribute to pathologic spine fractures which may be fatal eventually. Immediate spine decompression in orthopedics department is indicated in such condition.

The situation may be worse when patient is given ADT. I was proven that hypogonadism leads to osteopenia and finally to osteoporosis. As obese patients have lower levels of testosterone, abovementioned unfavorable factors may contribute to pathologic fractures.

To prevent such mournful course patients are advised to take bisphospfonates (alendronic, zolendronic, clodronic acid, etc.) or denosumab (RANK ligand inhibitor) which inhibit osteoclasts and slow down progression of the disease.
