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In an Oct. 14, 2026, MedPage Today interview, Cleveland Clinic oncologist Christopher Wee discussed balancing treatment effectiveness and quality of life for metastatic castration-sensitive prostate cancer. He described common side effects of androgen deprivation therapy and said continuous treatment remains the standard for metastatic disease, while decisions should account for patients’ health and priorities.
A MedPage Today interview published Oct. 14 examined how clinicians and patients can weigh treatment benefits against side effects in metastatic castration-sensitive prostate cancer. Cleveland Clinic oncologist Christopher Wee said androgen deprivation therapy (ADT) can cause a range of physical and emotional effects, while emphasizing that continuous ADT remains the standard approach for metastatic disease.
Wee told host John Mangels that patients commonly want to extend survival while preserving quality of life. He said treatment discussions should cover both the adverse effects patients may experience and the potential consequences of disease progression, including pain, fractures and other skeletal-related events. Preventing or delaying such problems can be part of the reason to treat even when a patient currently feels well.
Wee said ADT accounts for much of the side-effect burden in systemic treatment for this disease. Effects can include hot flashes, fatigue, muscle loss, reduced bone density, sexual dysfunction, mood changes and weight gain; he also cited a slight increase in heart-attack risk. He said many patients manage treatment without major disruption to their routines, but the severity can vary and is difficult to predict. The interview did not provide rates for these effects or a patient-specific risk estimate.
The discussion also addressed relugolix, an oral ADT option that Wee said some patients prefer because testosterone suppression can begin and reverse more quickly than with longer-acting injections. He described this as potentially giving patients more control if side effects become difficult. That does not change the general treatment recommendation: Wee said intermittent ADT is not preferred for metastatic disease, citing a trial that did not establish it as non-inferior to continuous treatment. He added that patients experiencing substantial difficulty can discuss their options and make informed decisions with their clinicians.
Balancing Treatment and Daily Life
The issue matters because treatment decisions involve both disease control and the effects of therapy on everyday life. Side effects can affect physical comfort, mood, sexual health and energy, while stopping or changing treatment may have implications for managing metastatic cancer. Wee’s comments frame these discussions as individualized: patients’ overall health, frailty and personal priorities should inform the treatment plan.
His account also points to a practical need for clinicians and patients to discuss problems early rather than treating side effects as an afterthought. The interview does not establish that any particular adjustment will be appropriate for every patient. Instead, it describes a shared decision-making approach that considers the reason for treatment, the possible burden and the person’s circumstances.
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ADT in Metastatic Disease
The interview is the third installment of MedPage Today’s Beyond Diagnosis series on metastatic castration-sensitive prostate cancer. The series covers treatment decisions and patient communication. Wee, who works in Cleveland Clinic’s genitourinary medical oncology program, discussed weighing treatment intensity against quality of life and tailoring care to health status and individual preferences.
ADT lowers testosterone, a key part of treatment for this form of prostate cancer. Wee contrasted injectable approaches, including the GnRH agonist leuprolide, with oral relugolix. He noted that patients may value the latter’s quicker on-and-off effect. However, the interview’s central treatment distinction is that continuous ADT remains the default for metastatic disease; the possibility of an oral option is not presented as evidence that intermittent treatment is equally effective.
“Most patients’ top priority in treating this disease is to extend overall survival as long as possible while maintaining their quality of life.”
— Christopher Wee, Cleveland Clinic oncologist
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Individual Risks Remain Unpredictable
Wee said it is hard to predict which patients will experience more severe side effects. The interview did not give figures on how often specific effects occur, identify which patients face the greatest risks, or spell out a monitoring schedule for issues such as bone loss or cardiovascular risk. It also did not provide details of the trial comparing intermittent and continuous ADT, beyond saying that non-inferiority of intermittent therapy was not established.
The comments are a discussion with one oncologist, not a new clinical guideline or study report. They do not establish that relugolix will prevent side effects or be suitable for everyone. Treatment choices and any changes to therapy depend on individual circumstances and should be discussed with the treating oncology team.
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Discussing Side Effects With Clinicians
For patients starting or receiving treatment, the practical next step described in the interview is to raise side effects and quality-of-life concerns with their clinician. Discussions can include which symptoms are occurring, how they affect daily activities, treatment goals and available options. Patients should not stop or alter prescribed ADT on their own; a clinician can help weigh the risks and benefits of any change.
The interview provides no announcement of a new treatment or scheduled follow-up milestone. It leaves the focus on ongoing conversations as treatment proceeds, with decisions tailored to the patient’s health, tolerance and priorities while recognizing continuous ADT as the stated standard for metastatic disease.
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Key Questions
What side effects of ADT did Christopher Wee describe?
He listed hot flashes, fatigue, muscle loss, bone-density loss, sexual dysfunction, mood changes and weight gain, as well as a slight increase in heart-attack risk. The interview did not give rates or individual risk estimates.
Is intermittent ADT the standard for metastatic prostate cancer?
No. Wee said continuous ADT remains the standard for metastatic disease. He said a trial did not establish intermittent treatment as non-inferior, while noting that patients having substantial difficulty can discuss informed choices with their clinicians.
Why might some patients prefer relugolix?
Wee said some patients like that relugolix is an oral option with quicker testosterone suppression and rebound than longer-acting injections. He did not say it eliminates side effects or is right for every patient.
Should patients stop ADT if side effects become difficult?
Patients should discuss difficult side effects and treatment concerns with their oncology team rather than changing or stopping prescribed treatment on their own. Wee said decisions should weigh treatment benefits, side effects and patient priorities.
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