Advanced Prostate Cancer Treated with Intermittent or Continuous Androgen Deprivation in the Randomised FinnProstate Study VII: Quality of Life and Adverse Effects

Salonen, Arto J.; Taari, Kimmo; Ala‐Opas, Martti; Viitanen, Jouko; Lundstedt, Seppo; Tammela, Teuvo L.J.

doi:10.1016/j.eururo.2012.07.040

Cited by 68 publications

(83 citation statements)

References 30 publications

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“…Some of these are associated with increased mortality or degrade the quality of life [4,5]. Some adverse events are associated with decreased testosterone due to ADT and can be resolved by the recovery of testosterone after ADT discontinuation [3].…”

Section: Factors Associated With Testosterone Recovery After Androgenmentioning

confidence: 99%

Factors associated with testosterone recovery after androgen deprivation therapy in patients with prostate cancer

Nam¹,

Choi²,

Ryu³

et al. 2018

European Urology Supplements

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Purpose:We investigated factors affecting testosterone recovery after androgen deprivation therapy (ADT) withdrawal in patients with prostate cancer. Materials and Methods:The medical records of patients who underwent radical prostatectomy with ADT were retrospectively reviewed. In all, 221 patients were included in the analysis. Testosterone recovery was defined as supra-castration (SC) (testosterone levels in serum >50 ng/dL) or out of hypogonadism (OH) (>300 ng/dL) after ADT withdrawal. Kaplan-Meier analyses were used to estimate testosterone recovery after ADT cessation. Cox regression analyses were used to determine the factors affecting the recovery of testosterone. Results: After ADT, 206 patients (93.2%) recovered to the SC level and 122 patients (55.2%) recovered to the OH level. Patients treated with ADT for ≤18 months recovered to OH in a mean of 6.8 months (74.6%), but patients treated with ADT for >18 months recovered in a mean of 9.7 months (27.5%). In multivariate analyses, age (hazard ratio [HR], 0.915; p<0.001), serum level of sex hormone-binding globulin (SHBG) (HR, 1.015; p=0.002), initial testosterone level (HR, 1.002; p=0.002), and ADT duration (HR, 0.915; p<0.001) were associated with recovery to the OH level after ADT withdrawal, and hypertension (HR, 0.697; p=0.029) and duration of ADT (HR, 0.979; p=0.012) were significantly associated with recovery to SC. Conclusions: In patients treated with ADT for ≤18 months, testosterone recovers to the OH level more often and faster after ADT cessation. Age, SHBG level, initial testosterone level, and ADT duration are associated with testosterone recovery.

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Section: Factors Associated With Testosterone Recovery After Androgenmentioning

confidence: 99%

Factors associated with testosterone recovery after androgen deprivation therapy in patients with prostate cancer

Nam¹,

Choi²,

Ryu³

et al. 2018

European Urology Supplements

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“…16 In another study, 15.7 per cent of men receiving intermittent ADT reported ED compared to only 7.9 per cent in the continuous ADT group (p=0.042). 17 This was an unusual finding -particularly as there was no difference in scores of overall sexual functioning. This could be a sampling error, with men with no sexual desire failing to answer questions relating to sex and sexuality.…”

mentioning

confidence: 95%

Management of erectile dysfunction in men treated with androgen deprivation therapy

Wilson

Atkinson

Hughes

2013

Trends Urol & Men's Health

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A 55-year-old man presented to his GP with worsening pain in his left hip. The pain was present during the night as well as in the day. A plain radiograph of the hip demonstrated a sclerotic lesion suspicious of a metastatic deposit. Subsequent investigations revealed a prostate-specific antigen (PSA) of 200ng/ml. Similarly, sclerotic lesions were noted in the right hip and ischium. Prostatic biopsies confirmed Gleason 4+3 adenocarcinoma of the prostate and he was entered into the STAMPEDE trial. He was randomised to receive luteinising hormone-releasing hormone agonist therapy alone, so was commenced on goserelin injections. Bicalutamide was given at the beginning of therapy to prevent tumour flare. Six months later, his PSA had fallen to 0.6ng/ml with a serum testosterone <0.4ng/dl. During a clinic appointment he complained of loss of libido and difficulty maintaining erections adequate for sexual intercourse. He was commenced on tadalafil (Cialis) tablets twice a week as first-line treatment. THE CASEE rectile dysfunction (ED) is the persistent inability to attain and maintain a penile erection satisfactory for sexual intercourse. ED is increasingly common with advancing age, but is even more pronounced in men with prostate cancer who receive androgen deprivation therapy (ADT). Reported rates of impotence in this group range from 50 to 100 per cent.The aetiology of ED in men with prostate cancer is often mixed. Vascular and/or neurological damage at prostatectomy or following radical radiotherapy explains some of the incidence, but even without these treatments, such as in this case, erectile problems are common. Hormonal, neurological, vascular and psychological factors contribute to a greater or lesser degree in different individuals. EFFECTS OF ANDROGEN DEPLETIONAndrogen deprivation therapy, by definition, causes sustained suppression of serum In this series, the authors present cases of men being treated with androgen deprivation therapy, and highlight their management to prevent and treat associated toxicities. This second article will consider the management of erectile dysfunction.

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“…In the SEUG (20) trial an increased risk of dying from cardiovascular disease in the continuous arm was reported (cardiovascular deaths: 52 [16.7%] in the continuous arm, 41 [13.1%] in the IAD group). Hence, in the FinnProstate VII trial (32), no significant differences arose between the treatment arms in terms of cardiovascular adverse effects (P = 0.59) and cardiovascular-related mortality (P = 0.38). Thus, due to limited existing data, this issue remains ambiguous and blinded randomized trials are required.…”

Section: Adverse Effects and Quality Of Lifementioning

confidence: 99%

“…Thus, patients with undetected PSA value and after induction treatment with AD should be considered as suitable for IAD. A SEUG (20) TULP (21) TAP22 (22) NCT3665 (23) SWOG (24) FinnProstate VII (32) Hot Flushes, % (43,44). According to the reviewed data, along with EAU guidelines, an induction cycle of 8 to 9 months is recommended.…”

Section: General Recommendations and Future Perspectivesmentioning

confidence: 99%

A review of continuous vs intermittent androgen deprivation therapy: Redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a perpetual dispute

Kratiras

Konstantinidis²,

Skriapas

2014

Int. braz j urol.

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ARTICLE INFO ______________________________________________________________ ______________________Objectives: To review the literature and present new data of continuous androgen deprivation therapy (ADT) vs intermittent androgen deprivation (IAD) as therapies for prostate cancer in terms of survival and quality of life and clarify practical issues in the use of IAD. Materials and Methods:We conducted a systematic search on Medline and Embase databases using "prostatic neoplasm" and "intermittent androgen deprivation" as search terms. We reviewed meta-analyses, randomised controlled trials, reviews, clinical trials and practise guidelines written in English from 2000 and onwards until 01/04/2013. Ten randomized controlled trials were identified. Seven of them published extensive data and results randomizing 4675 patients to IAD versus CAD. Data from the other three randomized trials were limited. Results: Over the last years studies confirmed that IAD is an effective alternative approach to hormonal deprivation providing simultaneously several potential benefits in terms of quality of life and cost effectiveness. Thus, in patients with non metastatic, advanced prostate cancer IAD could be used as standard treatment, while in metastatic prostate cancer IAD role still remains ambiguous. Conclusions: Nowadays, revaluation of the gold standard of ADT in advanced prostate cancer appears essential. Recent data established that IAD should no longer be considered as investigational, since its effectiveness has been proven, especially in patients suffering from non-metastatic advanced prostate cancer.

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Advanced Prostate Cancer Treated with Intermittent or Continuous Androgen Deprivation in the Randomised FinnProstate Study VII: Quality of Life and Adverse Effects

Cited by 68 publications

References 30 publications

Factors associated with testosterone recovery after androgen deprivation therapy in patients with prostate cancer

Factors associated with testosterone recovery after androgen deprivation therapy in patients with prostate cancer

Management of erectile dysfunction in men treated with androgen deprivation therapy

A review of continuous vs intermittent androgen deprivation therapy: Redefining the gold standard in the treatment of advanced prostate cancer. Myths, facts and new data on a perpetual dispute

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