Optimizing outcomes and quality of life in the hormonal treatment of prostate cancer.
We review the effectiveness of androgen-deprivation therapy (ADT) in the management of prostate cancer, and the effect that this treatment has on a patient's quality of life (QoL), based on discussions held at a European symposium on the management of prostate cancer. The overall QoL is reduced in asymptomatic men, and there are known decreases in cognitive function, self-esteem, libido and sexual function. Hot flashes are also a frequent problem. Prolonged ADT can lead to osteoporosis and subsequently fractures. Various effective methods exist to manage and minimize these side-effects; some are specific to the side-effect, whereas other more general methods include lifestyle changes, specific drugs and added hormonal manipulations. Intermittent ADT for patients taking luteinizing hormone-releasing hormone agonists offers a promising method to reduce adverse effects, and possibly increases the time to androgen independence. Initial studies indicate that prostate-specific antigen-based progression with intermittent ADT is similar to that seen with continuous ADT, but there is a reduction in side-effects, leading to an improvement in QoL.
Department of Urology, Clinique Mutualiste, St Etienne, France. nmottet@mutualite-loire.com
Nicolas
N
Mottet
Tommaso
T
Prayer-Galetti
Peter
P
Hammerer
Michael W
MW
Kattan
Ulf
U
Tunn
D000726:Androgen Antagonists / Q000627:therapeutic use*; D000740:Anemia / Q000139:chemically induced; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced; D003866:Depressive Disorder / Q000139:chemically induced; D050723:Fractures, Bone / Q000139:chemically induced; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000139:chemically induced; D010024:Osteoporosis / Q000139:chemically induced; D010146:Pain / Q000139:chemically induced; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced; D016896:Treatment Outcome
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal