Editing Hormonal Therapy (section)

== Recommended Investigations Prior to ADT initiation (2021 CUA Guidelines§) ==

=== History and Physical exam ===

* '''History (4)'''
*# '''Cardiometabolic'''
*## '''History of major adverse cardiac events (MACE)'''
*## '''Risk factors for cardiac disease'''
*## '''Previous VTE or stroke'''
*# '''Bone'''
*## '''Falls risk'''
* '''Physical exam (5)'''
*# '''Cardiometabolic'''
*## '''Blood pressure'''
*## '''Weight'''
*## '''Waist circumference'''
*## '''Calculation of body mass index (BMI)'''
*# '''Bone'''
*## '''Height'''

=== Labs ===

* '''Cardiometabolic'''
*# '''Diabetes screening (fasting plasma glucose, oral glucose tolerance test, or Hgb A1c level)'''
*# '''Lipid profile:'''
*## '''Triglycerides'''
*## '''Low-density lipoprotein [LDL] cholesterol'''
*## '''High-density lipoprotein [HDL] cholesterol'''
*## '''Total cholesterol'''
* '''Bone'''
*# '''Calcium'''
*# '''25-hydroxyvitamin D'''

=== Other ===

* '''Cardiometabolic'''
** '''Referral to a cardiologist or cardio-oncologist may be considered in patients with a history of myocardial infarction (MI) or stroke''', for assessment and medical optimization prior to initiating ADT
* '''Bone'''
** '''Bone mineral density (BMD) testing using dual energy x-ray absorptiometry (DXA)'''
*** '''Using a validated tool, results of BMD testing should be used to calculate a patient’s 10-year risk of a major osteoporotic fracture for consideration of pharmacological therapy.'''
**** Recommended tools for calculating fracture risk
***** Canadian Association of Radiologists and Osteoporosis Canada
***** Fracture Risk Assessment tool (FRAX) of the World Health Organization (WHO)
* Inform primary care provider that the patient has been initiated on ADT and that there may be adverse events associated with this therapy
* Counsel patient regarding sexual side effects, particularly with respect to body image.