Androgen deprivation therapy for prostate cancer: recommendations to improve patient and partner quality of life.
BACKGROUND
Because of improved prostate cancer detection, more patients begin androgen deprivation therapy (ADT) earlier and remain on it longer than before. Patients now may be androgen deprived for over a decade, even when they are otherwise free of cancer symptoms.


OBJECTIVE
An ADT Survivorship Working Group was formed to develop and evaluate interventions to limit the physiological and emotional trauma patients and their partners experience from this treatment.


METHODS
The multidisciplinary Working Group met for 2 days to define the challenges couples face when patients commence ADT. A writing sub-group was formed. It compiled the meeting's proceedings, reviewed the literature and, in consultation with the other members of the working group, wrote the manuscript.


METHODS
Expert opinion of the side effects of ADT that affect the quality of life (QOL) of patients and their partners and the recommendations for managing ADT to optimize QOL were based on the best available literature, clinical experience, and widespread internal discussions among Working Group members.


RESULTS
Side effects identified as particularly challenging include: (i) body feminization; (ii) changes in sexual performance; (iii) relationship changes; (iv) cognitive and affective symptoms; and (v) fatigue, sleep disturbance, and depression. Recommendations for managing ADT include providing information about ADT side effects before administration of ADT, and, where appropriate, providing referrals for psychosocial support. Sexual rehabilitation principles for persons with chronic illness may prove useful. Psychological interventions for sexual sequelae need to be offered and individualized to patients, regardless of their age or partnership. Support should also be offered to partners.


CONCLUSIONS
Our hope is that this plan will serve as a guide for optimizing how ADT is carried out and improve the lives of androgen-deprived men and their intimate partners.
Elliott
Stacy
S
BC Center for Sexual Medicine, Vancouver Hospital, Vancouver, BC, Canada.
Latini
David M
DM
Walker
Lauren M
LM
Wassersug
Richard
R
Robinson
John W
JW
D000726:Androgen Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects; D003863:Depression / Q000139:chemically induced; D007172:Erectile Dysfunction / Q000139:chemically induced / Q000628:therapy; D015444:Exercise; D005221:Fatigue / Q000139:chemically induced; D005262:Feminization / Q000139:chemically induced; D057220:Health Literacy; D006801:Humans; D007398:Interpersonal Relations; D007989:Libido / Q000187:drug effects; D008297:Male; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy*; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D012747:Sexual Partners; D012893:Sleep Wake Disorders / Q000139:chemically induced
D000726:Androgen Antagonists