BERKELEY, CA (UroToday.com) - Many treatment options exist for non-metastatic prostate cancer patients. Androgen deprivation therapy (ADT), which suppresses the production of testicular androgens by medical or surgical castration, is used in this setting as primary ADT (i.e., monotherapy) or in combination with external beam radiotherapy (EBRT). Despite demonstrated benefits of ADT, including reduction of tumor burden and delay in cancer progression, many patients will experience a number of adverse physical and emotional side effects potentially limiting its clinical utility.
In the current study, the CaPSURE longitudinal disease registry was used to determine the effect of ADT on mental and emotional well-being in men with non-metastatic prostate cancer. Among the 3 068 patients comprising the study cohort, exposure to ADT was associated with significant changes, over time, in adjusted role emotional and vitality scores compared to those patients treated only with surgery or radiation (using the RAND 36-Item Short-Form Health Survey). Men in the primary ADT group experienced the greatest changes in the vitality -- measuring energy/fatigue -- subscale by losing 9 points on the 0-100 scale. However, there were no clinically meaningful declines –- defined by a decrease of at least a half a standard deviation from the pretreatment mean score – noted at 24 months on any of the SF-36 emotional subscales. This suggests that while changes in emotional well-being likely occur over time for those treated with ADT either in combination with radiation or as primary ADT, there was no clinically meaningful decline in emotional well-being for these men at 2 years post-treatment.
Although we did not find a clinically meaningful decline in emotional quality of life (QoL) at 24 months, patients' emotional well-being seemed to fluctuate over time when treated with ADT. Patients should be counseled on this possibility of QoL changes while on ADT, as well as possible interventions which could attenuate these effects. For example, randomized trial and observational studies continue to suggest exercise regimens could benefit this group of patients in terms of multiple domains of both physical and psychological function.
Written by:
K. Clint Cary, MD, MPH as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology, University of California, San Francisco and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California USA
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