Psychological effects of androgen‐deprivation therapy on men with prostate cancer and their partners

Abstract

The clinical benefits of androgen-deprivation therapy (ADT) for men with prostate cancer (PC) have been well documented and include living free from the symptoms of metastases for longer periods and improved quality of life. However, ADT comes with a host of its own serious side effects. There is considerable evidence of the adverse cardiovascular, metabolic, and musculoskeletal effects of ADT. Far less has been written about the psychological effects of ADT. This review highlights several adverse psychological effects of ADT. The authors provide evidence for the effect of ADT on men's sexual function, their partner, and their sexual relationship. Evidence of increased emotional lability and depressed mood in men who receive ADT is also presented, and the risk of depression in the patient's partner is discussed. The evidence for adverse cognitive effects with ADT is still emerging but suggests that ADT is associated with impairment in multiple cognitive domains. Finally, the available literature is reviewed on interventions to mitigate the psychological effects of ADT. Across the array of adverse effects, physical exercise appears to have the greatest potential to address the psychological effects of ADT both in men who are receiving ADT and in their partners. Cancer 2015;121:4286-99. V C 2015 American Cancer Society.KEYWORDS: androgen-deprivation therapy, cognition, depression, prostate cancer, sexual function. INTRODUCTIONAndrogen-deprivation therapy (ADT) in the form of surgical castration or, more commonly, medical castration is the most common form of treatment for metastatic prostate cancer (PC). [1][2][3] The clinical benefits of ADT for men who have metastatic disease have been well documented and include living free from the symptoms of metastases for longer periods and improved quality of life. 3,4 The use of ADT has increased over time based on clinical trial evidence of improved outcomes. This is especially true for men with high-risk, localized PC who receive radiotherapy and for those with lymph node-positive PC who undergo radical prostatectomy. 1,5,6 In industrialized nations, 50% of men with PC can anticipate being prescribed ADT at some point during the course of their disease. 2 In North America, ADT is currently prescribed for more than 600,000 men with PC. 7 Furthermore, men are being exposed to ADT for periods as long as 5 to 10 years compared with a median duration of 2 to 5 years for patients with metastatic disease. 8 The objective of ADT for men with PC is to reduce levels of androgens-the hormones responsible for stimulating PC cell growth. The principal androgen, testosterone, plays a significant role in male morphology and is the primary determinant of men's sexual behavior, most notably their instinctual sex drive. Testosterone also has been described as a social hormone. 9 Thus, testosterone regulates not only men's desire for sex but also their tendency toward competiveness, dominance, reactive aggression, and stoic emotional presentation. [10][11][12] Descriptive studies of men w...

Men's Sexual and Relational Adaptations to Erectile Dysfunction After Prostate Cancer Treatment

“…Sexual dysfunction is particularly severe for men treated with ADT Donovan et al, 2015;Schover, 2015). In a recent study with a sample of 250 men on ADT (mean age 69), only 9% reported being sexually active 9 months after starting ADT (Ng et al, 2014).…”

Estradiol for the mitigation of adverse effects of androgen deprivation therapy

“…The included studies compared cognitive test performance with healthy controls, men with PCa not undergoing ADT, or individual pre-ADT baselines. Although available evidence does not suggest that ADT causes global cognitive dysfunction, the small sample sizes in studies to date preclude exclusion of negative effects of ADT in other cognitive domains (Donovan et al 2015). These impacts need to be confirmed in larger longitudinal controlled studies that attempt to adjust for the influence of other side effects of ADT that may affect cognition, for example, effects on mood and fatigue.…”

“…Men undergoing ADT generally experience loss of libido, erectile dysfunction and reduced sexual activity (Grossmann & Zajac 2011). Men frequently report an associated perceived loss of masculinity and reduced relational intimacy (Donovan et al 2015).…”

“…Animal studies indicate important roles for testosterone and E 2 in memory and learning but human studies have generally been small and have reached mixed conclusions. Studies in men undergoing ADT have also reported contradictory results (Donovan et al 2015). A systematic review of small observational controlled studies concluded that ADT appears to have subtle negative effects on specific limited cognitive domains such as visuospatial abilities and executive functioning (Nelson et al 2008).…”

“…Although the potential for unrecognized confounding remains, it seems likely that ADT causes more cases of depression. Whether this is a direct effect of medical castration or a result of other physical effects of ADT is unclear (Donovan et al 2015).…”