Risk of the "androgen deprivation syndrome" in men receiving androgen deprivation for prostate cancer.
BACKGROUND
Androgen deprivation therapy for prostate cancer has been associated with a spectrum of adverse effects, such as depression, memory difficulties, and fatigue, termed the androgen deprivation syndrome. Primary care physicians providing follow-up care for men with prostate cancer will be faced with managing these effects. We therefore sought to estimate the incidence of these effects and, by using a control group, ascertain whether these effects were related to androgen deprivation itself.


METHODS
We assessed the risk of physician diagnoses of depression, cognitive impairment, or constitutional symptoms in Medicare data following androgen deprivation using a sample of 50 613 men with incident prostate cancer and 50 476 men without cancer, from 1992 through 1997, in the linked Surveillance, Epidemiology, and End Results-Medicare database. Cox proportional hazards regression was used to adjust for confounding variables.


RESULTS
Of men surviving at least 5 years after diagnosis, 31.3% of those receiving androgen deprivation developed at least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7% in those who did not (P<.001). After adjustment for variables such as comorbidity, tumor characteristics, and age, the risks associated with androgen deprivation were substantially reduced or abolished: relative risk (RR) for depression diagnosis, 1.08 (95% confidence interval [CI], 1.02-1.15); RR for cognitive impairment, 0.99 (95% CI, 0.94-1.04); and RR for constitutional symptoms, 1.17 (95% CI, 1.13-1.22).


CONCLUSIONS
Depressive, cognitive, and constitutional disorders occur more commonly in patients receiving androgen deprivation, but this appears to be primarily because patients receiving androgen deprivation are older and have more comorbid conditions and more advanced cancers.
Shahinian
Vahakn B
VB
Department of Internal Medicine, and Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0562, USA. vbshahin@utmb.edu
Kuo
Yong-Fang
YF
Freeman
Jean L
JL
Goodwin
James S
JS
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000628:therapy*; D012307:Risk Factors; D013577:Syndrome
D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone