Adherence to Hormonal Therapies in Prostate Cancer

Abstract

Introduction: Hormonal therapy is the standard of care in prostate cancer treatment. The approval of the first oral androgen deprivation therapy, relugolix, to treat prostate cancer patients provides an opportunity to review adherence to oral and injectable/implantable hormonal therapies to aid patients and physicians in making informed decisions.Methods: A PubMed search for available literature on adherence to hormonal therapy in prostate cancer was conducted, including published data on relugolix.Results: Adherence to oral antiandrogen therapy was above 90% by medication possession ratio in several studies worldwide and from 75% to 91% by proportion of days covered. For injectable/implantable androgen deprivation therapy, adherence to treatment ranged from 71% to 95%. In general, 60% and 29% of injections were reported to be delayed by more than 1 week and 2 weeks, respectively, with some patients experiencing testosterone increases (tests above 50 ng/dL). Although real-world data on adherence to relugolix are currently unavailable, pharmacokinetic/pharmacodynamics models demonstrated that, if necessary, treatment interruption up to 7 days would still maintain testosterone suppression levels. Conclusions:In general, adherence to hormonal therapy is high in prostate cancer. Studies revealed that adherence to injectable androgen deprivation therapy dosing schedules is important to maintain castrate levels. Pharmacokinetic/pharmacodynamics models showed that relugolix treatment interruption up to 7 days had minimal impact on testosterone suppression levels.

Immunomodulatory effects of exercise in cancer prevention and adjuvant therapy: a narrative review

“…In addition, women with increased levels of estrogen show an elevated risk for developing endometrial cancer ( Friedenreich et al, 2020 ). Prostate cancer survival is significantly improved following anti-androgen therapy in men ( Hafron et al, 2023 ). The overall disease incidence is also improved using such therapeutic strategies as a preventative measure.…”

“…The association between sex hormones and exercise in men has not been well studied; however, in athletes, significantly lower levels of testosterone have been reported ( Moore et al, 2021 ). Excess androgen levels have been suggested to increase prostate cancer risk, while at the same time, finasteride, a testosterone-reducing medication, lowers prostate cancer incidence ( Hafron et al, 2023 ). However, there is also the report of finasteride increasing the risk of high-grade prostate cancers ( Hafron et al, 2023 ).…”

“…Excess androgen levels have been suggested to increase prostate cancer risk, while at the same time, finasteride, a testosterone-reducing medication, lowers prostate cancer incidence ( Hafron et al, 2023 ). However, there is also the report of finasteride increasing the risk of high-grade prostate cancers ( Hafron et al, 2023 ). Since a low level of testosterone is associated with obesity in men, the effect of exercise on testosterone gets further complicated ( Loh et al, 2022 ).…”