title: Neoadjuvant androgen deprivation therapy leads to immediate impairment of vitality/hormonal and sexual quality of life: results of a multicenter prospective study.
abstract: OBJECTIVE
  To evaluate the immediate effects of neoadjuvant androgen deprivation therapy (NADT) on health-related quality of life (HRQOL) among patients undergoing radiation therapy (RT) for newly diagnosed prostate cancer.
  
  
  METHODS
  The Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment Consortium is a prospective multi-institutional study. HRQOL is measured with the Expanded Prostate Cancer Index Composite-26 questionnaire. Differences in patient-reported HRQOL were observed between pretreatment and 2 months after NADT start (and before definitive RT) with significant differences evaluated by paired t test.
  
  
  RESULTS
  From among 450 patients who completed the Expanded Prostate Cancer Index Composite-26 before and 2 months after NADT start, 71 received NADT before proceeding with definitive RT. Patients receiving NADT experienced significant impairment in vitality/hormonal (P <.0001) and sexual (P <.0001) HRQOL after NADT initiation. The mean ± standard deviation vitality/hormonal score fell from an average of 94.1 ± 9.7 before NADT to 78.7 ± 16.3 two months after NADT initiation; and sexual HRQOL fell from a mean of 51.7 ± 31.1 pretreatment to 32.3 ± 26.1 after NADT initiation. Both these HRQOL domain changes exceeded the thresholds for clinical significance. Patients receiving NADT also experienced a significant impairment in urinary continence (P = .024), although this difference did not meet the criteria for clinical significance.
  
  
  CONCLUSIONS
  In this analysis, patients receiving NADT experience significant impairment in sexual and vitality/hormonal HRQOL even before starting definitive RT. The significant effect of this therapy on HRQOL needs to be considered before initiating NADT in men where there is no clear evidence of clinical benefit.
authors.affiliation: Department of Radiation Oncology, Washington University in Saint Louis, MO. Electronic address: hgay@radonc.wustl.edu.
authors.forename: Hiram Alberto
authors.initials: HA
authors.lastname: Gay
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Michalski
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hamstra
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
authors.forename: Howard M
authors.initials: HM
authors.lastname: Sandler
authors.forename: Chris
authors.initials: C
authors.lastname: Saigal
authors.forename: Mark
authors.initials: M
authors.lastname: Litwin
authors.forename: Deborah
authors.initials: D
authors.lastname: Kuban
authors.forename: Larry
authors.initials: L
authors.lastname: Hembroff
authors.forename: Peter
authors.initials: P
authors.lastname: Chang
authors.forename: Martin G
authors.initials: MG
authors.lastname: Sanda
mesh_terms: D001707:Biopsy, Needle / Q000706:statistics & numerical data; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011788:Quality of Life; D019564:Unnecessary Procedures