Sex or survival: short-term versus long-term androgen deprivation in patients with locally advanced prostate cancer treated with radiotherapy.
BACKGROUND
Combined long-term androgen deprivation (LTAD) and radiation conveys a prostate cancer-specific survival advantage over combined short-term androgen deprivation (STAD) and radiation. The seminal question is whether or not the gains are worth the adverse effects of LTAD with respect to patient preferences.


METHODS
Preferences for LTAD compared with STAD were elicited by direct patient interview using the probability trade-off method. "Time trade-off utilities" (TTOu) for erectile dysfunction and osteoporosis were elicited using the time trade-off method. Participants' current prostate cancer-specific health state was assessed using the Patient-Oriented Prostate Utility Scale-Psychometric. Participants' current sexual function was assessed using the International Index of Erectile Function (IIEF).


RESULTS
All participants were willing to trade survival rather than undergo LTAD compared with STAD. The mean minimally required increment in prostate cancer-specific survival (MRIS) was 8.2%. The mean TTOu for impotence was 0.78, and the mean TTOu for osteoporosis was 0.71. The MRIS was correlated with the Sexual Desire domain score of the IIEF (Spearman rank-correlation coefficient, r = 0.50; P<.0001).


CONCLUSIONS
Patients desired more prostate cancer-specific survival than what was afforded by LTAD and radiotherapy compared with STAD and radiotherapy.
Wilke
Derek R
DR
Department of Radiation Oncology, Nova Scotia Cancer Center, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Nova Scotia, Canada. ccdrw@cdha.nshealth.ca
Krahn
Murray
M
Tomlinson
George
G
Bezjak
Andrea
A
Rutledge
Robert
R
Warde
Padraig
P
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage*; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D003131:Combined Modality Therapy; D007172:Erectile Dysfunction / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D018570:Risk Assessment; D016896:Treatment Outcome
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal