Prostate Cancer Care: ADT Management and APP Guidance

In observance of Prostate Cancer Awareness Month, Oncology Nursing News spoke with Ghazal “Gigi” Jameel, APRN, Lead Advanced Practice Provider in the Genitourinary Oncology Program at Moffitt Cancer Center.

Advanced androgen deprivation therapy (ADT) and novel oral targeted regimens have improved survival outcomes for patients diagnosed with prostate cancer, yet managing treatment-related toxicities remains a component of comprehensive oncology nursing practice. Long-term ADT administration predisposes patients to bone mineral density reduction, metabolic alterations, increased cardiovascular risk, and persistent physical fatigue. Additionally, underreported quality-of-life issues — including hot flashes, urinary incontinence, and sexual dysfunction — require compassionate, structured communication from the entire interprofessional care team.

Jameel outlined evidence-based clinical interventions for ADT toxicities, practical approaches to facilitate open dialogue regarding sensitive side effects, actionable strategies for supporting oral therapy adherence, and collaborative workflows designed to optimize multidisciplinary care delivery in high-volume genitourinary outpatient cancer center clinic settings.

What standardized nursing interventions do you recommend to address long-term metabolic, cardiovascular, and bone health impacts of ADT?

Calcium and vitamin D supplementation is really important. I also counsel all of my patients, and nurses should as well, that weight-bearing exercise is a really important step to prevent bone fractures from long-term ADT use. Exercise with ADT can help mitigate those fatigue side effects. It can also mitigate that weight gain, especially around the abdomen, that a lot of our patients get. It's also been shown to help with hot flashes, too.

So, if nurses are able to intervene and really talk to our patients and spend time with them and discuss, "Hey, these are small steps you can do to help prevent all of these other side effects that happen," that is key.

How can oncology nurses create an open clinical environment to help patients discuss underreported quality of life concerns like sexual dysfunction or urinary incontinence?

I think meeting every patient where they're at. A lot of the time, these patients are older men who do not want to talk to a younger person about their sexual dysfunction. They don't want to say, "Hey, I'm having hot flashes". They don't want to talk about their fatigue. So, I think meeting the patient where they're at and getting to know them as a person before you step into, "I hear you're having some impotence issues," I think making a safe space for these men to feel comfortable discussing with nurses what's going on in their lives is essential.

What strategies can APPs and nurses use to improve treatment adherence for patients who are on complex self-administered oral targeted therapies?

That is a big hurdle that we deal with on a daily basis. Keeping the lines of communication open is really important. Especially when we have patients that come with their caregivers, utilizing those relationships with the nurses and the caregivers is really important. Because a lot of the time, the caregivers will say, "Well, my dad doesn't want to do X, Y, and Z. How can I get him to even drink more water every day?" Keeping the communication with the caregivers is really important as well. Follow up with the patient. Don't just say, "Hey, see you in 3 months." You want to see them at least monthly, especially on novel hormone treatments.

How can APPs, clinic RNs, and nurse navigators best structure their collaboration to optimize patient care in high-volume GU clinics?

Going back to communication, not only communicating with our patients, but we really need to be aware of communicating with each other. It's really important to keep those lines of communication open among clinic nurses, nurse navigators, and physicians, and work together as a team rather than being siloed in different parts of the clinic.