Enzalutamide for Prostate Cancer: Managing Fatigue, Dizziness, Hypertension, and Serious Neurocardiovascular Risks

　　1.Overview of Common Adverse Reactions

　　During enzalutamide therapy,patients may experience fatigue,asthenia,musculoskeletal pain,hot flashes,decreased appetite,dizziness,and nausea.Some develop hypertension,increased fall risk,or fractures.Less common but clinically important are seizures,posterior reversible encephalopathy syndrome(PRES),and ischemic heart disease.Management should grade symptoms as mild,moderate,or severe rather than attributing everything to“expected side effects.”

　　2.Fatigue and Asthenia:Adjust Routine,Then Investigate

　　Fatigue is frequent.Schedule activities according to tolerance,avoid prolonged intense exertion,and maintain regular sleep and balanced nutrition.If fatigue worsens persistently or impairs daily life,evaluate anemia,infection,nutritional or electrolyte abnormalities,endocrine issues,and possible disease progression instead of assuming drug cause alone.Clinicians decide continuation based on blood counts,biochemistry,nutritional status,and imaging.

　　3.Dizziness and Falls:Prioritize Older Adults and Bone Metastases

　　Dizziness and impaired balance raise fall risk,especially in older patients,those with bone metastases,osteoporosis,or concomitant sedatives.Change position slowly when getting up or standing;avoid climbing,driving while symptomatic,or other high-risk activities.After a fall,sudden severe bone pain,or suspected fracture,perform prompt clinical and imaging evaluation,with orthopedics referral when needed.

　　4.Hypertension and General Monitoring

　　Monitor blood pressure at scheduled intervals during treatment.Patients with preexisting hypertension need more frequent checks and home-blood-pressure logging.Drug-related mild elevation may be managed after physician review;do not self-add or up-titrate antihypertensives.Track appetite,weight,and muscle strength to assess overall tolerability.

　　5.Red Flags:Do Not Merely“Relieve Side Effects”

　　Seek urgent medical evaluation for altered consciousness,seizure,severe headache,visual disturbance,chest pain,dyspnea,or focal neurologic deficits.Prescribing information warns about seizure and PRES;ischemic heart disease and new heart-failure symptoms also require prompt workup.For persistent or severe adverse reactions,clinicians may hold,reduce,or switch therapy rather than continue unchanged.