Prostate Cancer Patients Receiving ADT Should be
Counseled to Improve Mental Well-Being
Previous studies have reported cognitive and
affective symptoms following ADT, particularly in the elderly
Jan. 24, 2014 A new study published in the
Journal of Urology reports that prostate cancer patients treated
with androgen deprivation therapy (ADT) experienced changes in mental
and emotional well-being during treatment, although there was no
meaningful decline in emotional quality of life two years after
treatment. Previous studies have reported cognitive and affective
symptoms following ADT, particularly in the elderly. Symptoms include
emotional upset (tearfulness, irritability, and anger), decreased
motivation, hopelessness, and cognitive interruptions in attention,
memory, and visual processing.
Investigators at the University of California-San
Francisco recommend counseling men about the potential adverse effects
of ADT as well as the interventions to improve mental and emotional
health such as exercise programs and diet.
Nearly 240,000 men were expected to be diagnosed
with prostate cancer in the United States in 2013, with around 30,000
deaths. Treatment for prostate cancer is associated with significant
Age is the most important risk factor for prostate
cancer. The disease is extremely rare in men under age 40, but the risk
increases greatly with age. More than 60 percent of cases are diagnosed
in men over age 65. The average age at the time of diagnosis is 65.
Some of these patients are likely to experience
more adverse side-effects and complications from the treatment than from
the cancer itself. Earlier studies have suggested that treatment may
also affect mental and emotional health.
ADT, which suppresses the production of
testosterone by either medical or surgical castration, remains the gold
standard for treating advanced prostate cancer, either alone or with
radiation therapy. Benefits include reduction of tumor burden, delayed
cancer progression, and overall improvement in survival in some cases.
However, ADT has a number of physical side-effects, including hot
flashes, decreased libido, fatigue, decreased bone and muscle mass,
increased total body fat content, and possible harmful cardiovascular
Some studies have linked ADT use to depression,
although it is not clear whether such effects are a direct consequence
of ADT itself or perhaps associated with age, comorbidities, hot
flashes, fatigue, and insomnia.
The current authors evaluated the effects of ADT on
mental and emotional well-being in men diagnosed with localized prostate
cancer using data from the CaPSURE (Cancer of the Prostate Strategic
Urologic Research Endeavor) registry, which consists of data from
largely community-based practices across the United States. Over 3,000
men completed a pretreatment and at least one posttreatment quality of
life assessment checklist.
The authors focused on men newly diagnosed with
localized (non-metastatic) prostate cancer in 1995-2011 and treated with
radical prostatectomy, brachytherapy, radiation therapy, or primary
androgen deprivation therapy (PADT).
Of men included in the study 75% were treated with
local therapy, 20% combination treatment, and five percent PADT. Among
men in the PADT group, 84% were treated with luteinizing
hormone-releasing hormone agonist monotherapy and 16% received combined
Approximately 36% of patients reported some type of
mental impairment at pretreatment evaluation, including depression,
insomnia, confusion, poor concentration, sleep disturbances,
nervousness, or poor memory. There were no overall differences in rates
of mental health symptoms at diagnosis among treatment groups, although
18% of the PADT group reported poorer memory compared to 12% in the
local group and 15% in the combination group.
Analysis demonstrated that exposure to ADT was
associated with significant changes in mental and emotional well-being
but did not result in clinically meaningful declines at 24 months.
"These results could be related to men in the ADT group adapting to
their symptoms over time, thus reporting improves scores," explains lead
investigator Clint Cary, MD, MPH, of the Department of Urology at the
University of California-San Francisco.
The most pronounced effect of ADT was on vitality.
"This result corroborates other studies documenting fatigue among the
most commonly reported side effects of ADT," says Cary. "It is not clear
though whether the fatigue is a direct effect of ADT itself or a
consequence of the physical side effects of ADT, such as sleep
disturbances or hot flashes."
Cary recommends that patients are counseled on
possible ADT-related quality of life changes, as well as ways to
minimize these changes before treatment for prostate cancer. "All
patients should be well informed about the potential adverse effects of
ADT, and interventions to improve mental and emotional health such as
exercise programs and dietary/lifestyles changes could be of particular
importance," he concludes.
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