Avaliação da função endotelial através da dilatação fluxo-mediada da artéria braquial e dos efeitos metabólicos da terapia de deprivação androgênica em pacientes com câncer de próstata

Abstract

Androgen deprivation therapy (ADT) is considered one of the mainstays in the treatment of patients with prostate cancer (PCa). Although it increases survival, this treatment is related to several side effects, such as increased cardiovascular risk (CVR), changes in body composition and several metabolic changes. Despite the well-established association between the level of circulating testosterone and the integrity of the endothelium, the results of studies that evaluated the influence of ADT on endothelium function are divergent. The aim of the present study was to investigate the impact of ADT on endothelial function, through the analysis of flow-mediated dilation of the brachial artery (FMD), its influence on the inflammatory marker C-reactive protein andalso on metabolic profile of patients, through measurement of serum total cholesterol and fractions, triglycerides, fasting glucose, glycated hemoglobin, basal insulin andassessment of anthropometric parameters and body composition. Patients underwent Doppler ultrasonography for FMD calculation, bioimpedance examination, as well as blood sampling for biochemical analysis before the introduction of ADT and three months after its initiation. Smokers and those who had quit smoking for the less five years, descompensated diabetics and those who had already had a cardiovascular event were excluded. From november 2021 to august 2022, 19 patients with PCa undergoing ADT from the Urology Outpatient Clinic of the Hospital UniversitárioWalter Cantídio were evaluated. The mean age of the patients studied was 67,42 ± 6,85 years. After 12 weeks, a non-significant increase in FMD was observed, wich ranged from 5,27% to 7,50% (p=0,60). A deterioration of the metabolic parameters was also observed, despite the absence of significant changes in body composition and anthropometric measurements. Although no significant change in FMD was demonstrated, important metabolic changes were observed after the onset of ADT, suchas increased insulin resistance and dyslipidemia, which are well-established CVR factors.