(UroToday.com) The 2023 American Society for Radiation Oncology (ASTRO) 65th Annual Meeting held in San Diego, CA was host to a session on patient-reported quality of life in prostate cancer. Dr. Abdenour Nabid discussed the results of an analysis of patient reported outcomes in high-risk prostate cancer patients with or without testosterone recovery following ADT.
In this analysis, the authors utilized the validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Prostate Cancer-25 (EORTC QLQ-PR25) questionnaire, which evaluates the following domains among prostate cancer patients:
- Urinary symptoms (number of items = 8)
- Incontinence aid (n=1)
- Bowel symptoms (n=4)
- Hormonal related symptoms (n=6)
- Sexual activity (n=2)
- Sexual functioning (n=4)
The EORTC QLQ-PR25 was administered at baseline, every 6 months while on ADT, 4 months following ADT, and subsequently once a year for 5 years. The global adherence to the questionnaire was 84% (2,649/3,156 respondents) and was similar among patients with and without testosterone recovery. From a statistical analysis endpoint, all items and scale scores were linearly transformed to a 0 – 100 points scale, with all items and scales analysed by general linear models with repeated measures to evaluate changes between patients with or without testosterone recovery over time. A clinically relevant difference was defined as a mean difference in score of at least 10 points. Testosterone recovery was adjusted in a multivariable model that included age, presence/absence of initial normal testosterone levels, and ADT duration (18 or 36 months).
For the purposes of this analysis, the authors only included patients meeting the following eligibility criteria:
- No evidence of biochemical failure
- ADT received for exactly 18 or 36 months
- Patients survived more than 1 year after randomization
- Had testosterone levels measured at baseline and during follow-up
- Completed the EORTC QLQ-PR25 questionnaire
269 patients met the eligibility criteria, and they were followed for a median of 14 years.
How did testosterone recovery vary in patients who received 18 versus 36 months of ADT? Overall, 52.2% of patients recovered their testosterone levels. This proportion was non-significantly higher in those who received 18 versus 36 months of ADT (57% versus 45%, p=0.056). The median time to testosterone recovery was significantly shorter in the 18 months group (3 versus 5 years, p<0.001).
Patients who recovered their testosterone levels had significantly improved scores for the following items:
- Difficulty getting enough sleep
- Blood in stools
- Hot flushes
- “Feeling less like a man”
- Interest in sex
- Sexual activity
With regards to clinically meaningful differences only, the authors determined that patients who recovered their testosterone levels had clinically meaningful improvements in the ‘hot flushes’ and ‘interest in sex’ items:
Dr. Nahid concluded his presentation with the following take home messages:
- Testosterone recovery after long-term ADT is associated with a significantly improved quality of life in patients with high-risk prostate cancer
- Considering similar prostate cancer clinical outcomes and faster testosterone recovery, these results suggest that 18 months of ADT may be the most appropriate ADT treatment duration for these patients from a quality of life outcomes perspective
Presented by: Abdenour Nabid, MD, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
Written by: Rashid K. Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2023 American Society for Therapeutic Radiation Oncology (ASTRO) 65th Annual Meeting held in San Diego, CA between October 1st and 4th, 2023