BERKELEY, CA (UroToday.com) - Prostate cancer currently accounts for approximately 30% of cancers diagnosed each year in Australian men.[1] The risk of a diagnosis of prostate cancer increases with age, being approximately 1 in 8 to 10 men aged 70 years or older.
Treatment paradigms are becoming progressively more sophisticated, and with continued improvement in survival rates, men are living for extended periods of time with their prostate cancer. Androgen deprivation therapy (ADT) is an integral part of the treatment of advanced prostate cancer and is increasingly being used early in the disease course for high-risk cancers. Whilst the benefits of an androgen-deficient state are well described, consideration of the inevitable adverse cardiometabolic and bone milieu and the potential detrimental effects on quality of life must form part of the individualised management plan. An appropriate strategy for screening for, and treating, metabolic, cardiac and bone issues, and for addressing immediate side-effects such as vasomotor symptoms and sexual dysfunction should be implemented when a man begins his treatment with ADT.
The age demographic of the male population diagnosed with prostate cancer is such that many men will already have experienced one or more of the potential comorbidities associated with ADT – type 2 diabetes, ischaemic heart disease, and osteoporosis. These men will already have relevant therapeutic strategies in place and their treating physicians will be able to incorporate any adverse effects from the ADT into pre-existing management plans. Men not previously diagnosed with these comorbidities should have a full baseline assessment, as outlined in the manuscript, with appropriate individualised follow-up or treatment. Biochemical surveillance (glucose, lipids, Vitamin D, full blood examination) can be measured concurrent with PSA levels.
A man, once diagnosed with advanced prostate cancer, is likely to be introduced to a multidisciplinary team potentially comprising urologists, radiation oncologists, oncologists, endocrinologists, cardiologists and primary care physicians, and supported by urology nurses. The expertise of dieticians, psychologists, continence advisors, and exercise physiologists may also be called upon. The support, advice and treatments offered by this array of heath professionals can be beneficial to a man’s prostate cancer trajectory,[2, 3] but on the other hand, the man can be faced with an overwhelming amount of information at a time that is already stressful due to the cancer diagnosis and what this may mean for the man’s life.
Men are faced with many decisions along the prostate cancer path, from the asymptomatic man deciding whether to have a PSA test, to decisions about treatments for early or advanced prostate cancer and, for some, end-of-life decisions. It is widely agreed that shared, informed, decision making between patient and health professional at each stage of prostate cancer diagnosis and treatment is best practice. However, low health literacy can be an impediment to the man fully participating in the process.
Providing accessible information tailored to a man’s age and needs, including his level of literacy, and allowing time for adequate discussion about the benefits and harms of prostate cancer treatments, including ADT, is a challenge for all health professionals. However, if done well, the man has the opportunity to be proactive in optimising his health within the context of his prostate cancer. Many organisations, including Andrology Australia, the Prostate Cancer Foundation of Australia, the Urological Society of Australia and New Zealand, the American Cancer Society, the European Society for Medical Oncology, and Prostate Cancer UK, provide this information in a variety of formats including print, web-based, video, YouTube clips, and e-books. Decision aids are also helpful for some men in navigating the treatment options.[4] Increasingly, patients are attending consultations armed with information gleaned from the Internet and will rely on their treating health professionals to help them sort the good from the bad. Pointing to reliable evidence-based information can go some way to help men make decisions that are right according to their own values and medical circumstances.
Resources on ADT and other prostate cancer treatments are available from Andrology Australia: www.youtube.com/user/AndrologyAust .
References:
- Australian Institute of Health and Welfare. (2012). Cancer incidence projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: AIHW.
- Gomella LG, Lin J, Hoffman-Censits J, Dugan P, Guiles F, Lallas CD, et a. Enhancing prostate cancer care through the multidisciplinary clinic approach: a 15-year experience. Journal of Oncology Practice/American Society of Clinical Oncology 2010: 6(6); e5-e10.
- British Uro-oncology Group and the British Association of Urological Surgeons Section of Oncology: Multi-disciplinary team (MDT) guidance for managing prostate cancer.
- Lin GA, Aaronson DS, Knight SJ, Carroll PR, Dudley RA. Patient decision aids for prostate cancer treatment: a systematic review of the literature. CA Cancer J Clin 2009: 59(6); 379-390.
Written by:
Carolyn A. Allan,a, b, c, d Veronica R Collins,b Mark Frydenberg,e, f Robert I. McLachlan,a, b, c, d and Kati L. Matthiessona, g 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.
aMonash Institute of Medical Research-Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia; bAndrology Australia, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia; cDepartment of Endocrinology, Monash Health, Melbourne, Victoria, Australia; dDepartment of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia; eDepartment of Surgery, Monash University, Clayton, Victoria, Australia; fDepartment of Urology, Monash Health, Melbourne, Victoria, Australia; gMedical Program, Monash Health, Melbourne, Victoria, Australia.
Corresponding Author:
Adjunct Clinical Associate Professor Carolyn Allan
MIMR-PHI Institute of Medical Research
27-31 Wright Street, Clayton, VIC 3168
www.monashinstitute.org
www.princehenrys.org
e-mail:
Androgen deprivation therapy complications - Abstract