Impact of androgen deprivation on physical well‐being in patients with prostate cancer

Sadetsky, Natalia; Greene, Kirsten L.; Cooperberg, Matthew R.; Hubbard, Alan; Carroll, Peter R.; Satariano, William A.

doi:10.1002/cncr.26064

Cited by 30 publications

(6 citation statements)

References 41 publications

(49 reference statements)

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“…31,32 ADT usage is known to cause fatigue, muscle weakness, and weight gain which may cause a decline in perceived general health. 33 In men undergoing radiation therapy, the late morbidity from treatment with older EBRT techniques may partly explain this decline. 34,35 Recent technical improvements such as intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) may reduce such an effect 36 but were not widely disseminated until after collection of this data.…”

Section: Discussionmentioning

confidence: 99%

Impact of diagnosis and treatment of clinically localized prostate cancer on health‐related quality of life for older Americans

Reeve

Stover

Jensen

et al. 2012

Cancer

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Background Few studies have measured the longitudinal change in health-related quality of life (HRQOL) of prostate cancer patients starting prior to cancer diagnosis, or provide simultaneous comparisons with a matched non-cancer cohort. Our study addresses these gaps by providing unique estimates of the effects of a cancer diagnosis on HRQOL accounting for the confounding effects of ageing and comorbidity. Methods The Surveillance, Epidemiology, and End Results registry data were linked with the Medicare Health Outcomes Survey (MHOS) data. Eligible patients (n=445) were Medicare beneficiaries, aged 65 years and older, from 1998–2003 whose first prostate cancer diagnosis occurred between their baseline and follow-up MHOS. Using propensity score matching, we identified 2225 participants without cancer in the MHOS. Analysis of covariance models were used to estimate changes in HRQOL as assessed with the Short Form-36 and activities of daily living scale. Results Before diagnosis, prostate cancer patients reported similar HRQOL to men without cancer. Following diagnosis, men with prostate cancer experienced significant decrements in physical, mental, and social aspects of their lives relative to controls, especially within the first 6 months from diagnosis. For men surveyed beyond one year after diagnosis, HRQOL was similar to controls. However, we observed an increased risk for major depressive disorder among men undergoing either conservative management or external beam radiation. Conclusions These findings illustrate the time-sensitive nature of decline in HRQOL after a cancer diagnosis and enhance our understanding of the impact of prostate cancer diagnosis and treatment on older men’ physical, mental, and social well-being.

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Section: Discussionmentioning

confidence: 99%

Impact of diagnosis and treatment of clinically localized prostate cancer on health‐related quality of life for older Americans

Reeve

Stover

Jensen

et al. 2012

Cancer

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“…Early use of PADT carries significant morbidity, including a 10–50% increase in the risks of fracture, diabetes, weight gain, hot flashes, decreased muscle tone, impotence, coronary heart disease, myocardial infarction, and sudden cardiac death [7–10]. Androgen-deprivation therapy (ADT) not only is associated with numerous treatment-related complications and more severe decline in physical well-being but also is costly [11]. …”

Section: Introductionmentioning

confidence: 99%

Does Primary Androgen-Deprivation Therapy Delay the Receipt of Secondary Cancer Therapy for Localized Prostate Cancer?

Lu‐Yao

Albertsen

et al. 2012

European Urology

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Background Despite evidence that shows no survival advantage, many older patients receive primary androgen-deprivation therapy (PADT) shortly after the diagnosis of localized prostate cancer (PCa). Objective This study evaluates whether the early use of PADT affects the subsequent receipt of additional palliative cancer treatments such as chemotherapy, palliative radiation therapy, or intervention for spinal cord compression or bladder outlet obstruction. Design, setting, and participants This longitudinal population-based cohort study consists of Medicare patients aged ≥66 yr diagnosed with localized PCa from 1992 to 2006 in areas covered by the Surveillance Epidemiology and End Results (SEER) program. SEER-Medicare linked data through 2009 were used to identify the use of PADT and palliative cancer therapy. Outcome measurements and statistical analysis Instrumental variable analysis methods were used to minimize confounding effects. Confidence intervals were derived from the bootstrap estimates. Results and limitations This study includes 29 775 men who did not receive local therapy for T1–T2 PCa within the first year of cancer diagnosis. Among low-risk patients (Gleason score 2–7 in 1992–2002 and Gleason score 2–6 in 2003–2006) with a median age of 78 yr and a median follow-up of 10.3 yr, PADT was associated with a 25% higher use of chemotherapy (hazard ratio [HR]: 1.25; 95% confidence interval [CI], 1.08–1.44) and a borderline higher use of any palliative cancer surgery (HR: 1.07; 95% CI, 0.97– 1.19) within 10 yr of diagnosis in regions with high PADT use compared with regions with low PADT use. Because this study was limited to men >65 yr, the results may not be applicable to younger patients. Conclusions Early treatment of low-risk, localized PCa with PADT does not delay the receipt of subsequent palliative therapies and is associated with an increased use of chemotherapy.

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“…Although body image perception was inferior in men on ADT, this correlated weakly with depression, suggesting that there may be a direct effect of low testosterone levels on the brain. A report of quality of life from the CaPSURE database, found significant declines in the domains of physical function and vitality after exposure to ADT 43 . Further exploration of these outcomes in the adjuvant setting is urgently needed, and interventional trials studying the potential for lifestyle modification to preserve quality of life and physical function should have high priority.…”

Section: What Are the Costs Of (Neo)adjuvant Therapy?mentioning

confidence: 99%

Current role of neoadjuvant and adjuvant systemic therapy for high-risk localized prostate cancer

Dorff

Glodé²

2013

Current Opinion in Urology

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Purpose of review While most men are diagnosed with readily curable localized prostate cancer, those with high risk features face a significant mortality risk. Androgen deprivation therapy (ADT) is a standard adjunct to radiotherapy for high-risk prostate cancer, but its role around prostatectomy has not been as clearly defined, and concerns over cardiovascular toxicity have led to decreasing use. The use of chemotherapy for localized disease remains experimental. We review the most recently published trials of neoadjuvant or adjuvant systemic therapy for prostate cancer. Recent findings The optimal duration of ADT with higher-dose modern radiation techniques is under active investigation, but current data support the use of longer duration as standard. PSA and MRI changes may be useful in future studies optimizing duration of neoadjuvant ADT. Two years of combined ADT after prostatectomy is associated with a lower risk of disease recurrence and better PCSM than predicted. Persistence of intraprostatic androgens during neoadjuvant ADT may contribute to resistance. Summary Androgen deprivation added to definitive radiation or surgery improves outcomes for high-risk prostate cancer, while the role of chemotherapy remains undefined. Molecular classification is needed to improve risk stratification.

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Impact of androgen deprivation on physical well‐being in patients with prostate cancer

Cited by 30 publications

References 41 publications

Impact of diagnosis and treatment of clinically localized prostate cancer on health‐related quality of life for older Americans

Impact of diagnosis and treatment of clinically localized prostate cancer on health‐related quality of life for older Americans

Does Primary Androgen-Deprivation Therapy Delay the Receipt of Secondary Cancer Therapy for Localized Prostate Cancer?

Current role of neoadjuvant and adjuvant systemic therapy for high-risk localized prostate cancer

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