Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study.
OBJECTIVE
To compare health-related quality-of-life outcomes after primary androgen deprivation (AD) therapy with orchiectomy versus luteinizing hormone-releasing hormone (LHRH) agonists for patients with prostate cancer.


METHODS
Men (n = 431) newly diagnosed with all stages of prostate cancer from six geographic regions who participated in the Prostate Cancer Outcomes Study and who received primary AD therapy but no other treatments within 12 months of initial diagnosis were included in a study of health outcomes. Comparisons were statistically adjusted for patient sociodemographic and clinical characteristics, timing of therapy, and use of combined androgen blockade.


RESULTS
More than half of the patients receiving primary AD therapy had been initially diagnosed with clinically localized prostate cancer. Among these patients, almost two thirds were at high risk of progression on the basis of prognostic factors. Sexual function outcomes were similar by treatment group both before and after implementation of AD therapy. LHRH patients reported more breast swelling than did orchiectomy patients (24.9% v 9.7%, P <.01). LHRH patients reported more physical discomfort and worry because of cancer or its treatment than did orchiectomy patients. LHRH patients assessed their overall health as fair or poor more frequently than did orchiectomy patients (35.4% v 28.1%, P =.01) and also were less likely to consider themselves free of prostate cancer after treatment.


CONCLUSIONS
Most endocrine-related health outcomes are similar after surgical versus medical primary hormonal therapy. Stage at diagnosis had little effect on outcomes. These results provide representative information comparing surgical and medical AD therapy that may be used by physicians and patients to inform treatment decisions.
Potosky
A L
AL
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA. potosky@nih.gov
Knopf
K
K
Clegg
L X
LX
Albertsen
P C
PC
Stanford
J L
JL
Hamilton
A S
AS
Gilliland
F D
FD
Eley
J W
JW
Stephenson
R A
RA
Hoffman
R M
RM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D011788:Quality of Life; D012044:Regression Analysis; D019529:Sexuality
D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide