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In an October 14, 2026, MedPage Today interview, Cleveland Clinic oncologist Christopher Wee discussed balancing treatment benefits and side effects for metastatic castration-sensitive prostate cancer. He described common effects of androgen deprivation therapy and said continuous therapy remains the standard, while patients and clinicians can discuss individual risks and priorities.
A MedPage Today interview published October 14, 2026 examined how clinicians can balance treatment and quality of life for people with metastatic castration-sensitive prostate cancer. Cleveland Clinic oncologist Christopher Wee said androgen deprivation therapy (ADT) can cause burdensome side effects, but continuous ADT remains the standard approach for metastatic disease; patients should discuss their symptoms, health and priorities with their care team.
Wee said treatment discussions often center on patients’ goal of extending survival while preserving quality of life. He described ADT as the main contributor to many side effects during systemic treatment, which may also include an androgen receptor pathway inhibitor or chemotherapy. Reported effects include hot flashes, fatigue, muscle and bone density loss, sexual dysfunction, mood changes and weight gain. He also cited a slightly increased risk of heart attacks. The interview did not provide individual risk estimates or advice for managing each effect.
Wee said many patients manage treatment without major disruption to their lives, but the severity of side effects is difficult to predict. He encourages patients to try treatment and see how they respond, while discussing the potential harms as well as the benefits of controlling cancer. He also noted that treatment may help delay problems associated with disease progression, including pain, fractures and other skeletal-related events.
The interview discussed relugolix, an oral ADT option, alongside injectable GnRH agonists such as leuprolide. Wee said patients may value relugolix because it can be stopped without remaining on a long-acting injection for months, and testosterone may rebound after stopping. That possibility does not make intermittent treatment the default for metastatic disease, he said: continuous ADT remains standard.
Balancing Cancer Control and Daily Life
ADT side effects can affect energy, physical strength, sexual function, mood and weight, making treatment decisions consequential beyond cancer control. Talking through expected effects and a patient’s health and priorities can help clinicians and patients make decisions together and address problems that arise during care.
Wee also emphasized a less immediate trade-off: treatment may be intended to delay complications even when a patient feels well. The interview presents that as a point for discussion, not a guarantee that a particular treatment will prevent a specific complication for every patient. Decisions about side effects, cancer control and treatment intensity need to be individualized with the oncology team.
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Why Continuous ADT Remains the Default
ADT lowers testosterone, which can fuel prostate cancer growth. The interview describes its use as part of systemic treatment for metastatic castration-sensitive disease, with other therapies such as androgen receptor pathway inhibitors or chemotherapy also discussed. The source does not compare specific drug regimens or provide new clinical trial results.
Wee said a trial comparing intermittent and continuous ADT in metastatic disease did not establish that intermittent treatment was non-inferior. On that basis, he said, continuous treatment is the current standard. He added that a patient experiencing substantial difficulty may still weigh the risks and benefits with clinicians and make an informed decision about what is right for them.
“Most patients get through with manageable toxicity, that they don’t have to necessarily upend their lifestyle, but some people get it worse and it’s hard to predict that.”
— Christopher Wee
Individual Side Effects Remain Unpredictable
The interview did not quantify how often particular side effects occur, identify which patients are most likely to experience them, or give a detailed management plan for each symptom. It also did not provide patient-specific recommendations about changing, pausing or stopping treatment. Wee said side effect severity is hard to predict, so readers should not treat the discussion as a substitute for advice from their own cancer care team.
Although Wee described testosterone rebound and easing side effects as possible after stopping relugolix, the interview did not state how quickly this occurs for every patient or whether it is appropriate for a particular person. It also did not present new trial data or change the stated standard of continuous ADT for metastatic disease.
Discuss Symptoms With the Care Team
Patients considering or receiving ADT can raise side effects, overall health, frailty and personal priorities with their oncologist. The interview points to shared decision-making as a way to weigh treatment goals against tolerability. Patients should seek individualized guidance before changing or stopping medication, particularly because continuous ADT remains the standard approach described for metastatic disease.
The source is an interview installment in MedPage Today’s “Beyond Diagnosis” series, rather than a clinical guideline or announcement of a treatment change. It does not identify a new milestone or a forthcoming study; the next practical step for patients is an individualized discussion with their treating clinician.
Key Questions
What side effects of ADT did the interview describe?
Wee listed hot flashes, fatigue, muscle and bone density loss, sexual dysfunction, mood changes and weight gain, as well as a slightly increased heart attack risk. The interview did not give individual risk estimates.
Is intermittent ADT the standard for metastatic prostate cancer?
No. Wee said continuous ADT remains the standard for metastatic disease because a trial did not establish intermittent therapy as non-inferior. Patients with significant treatment difficulties can discuss their options with their care team.
How does relugolix differ from an ADT injection?
Relugolix is an oral ADT medicine, while leuprolide is commonly given by injection. Wee said some patients value relugolix because it can be stopped without a long-acting injection continuing for months. Whether it suits a particular patient is a decision for the treating clinician and patient.
Should a patient stop ADT if side effects become difficult?
The interview does not offer a recommendation to stop treatment. Patients should contact their oncology team to discuss symptoms and treatment choices rather than changing or stopping medication on their own.
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