Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer

Spry, Nigel; Kristjanson, Linda J.; Hooton, B.W.; Hayden, Lawrence J.; Neerhut, Gregory; Gurney, Howard; Corica, Tammy; Korbel, E. I.; Weinstein, Sydney; McCaul, Kieran

doi:10.1016/j.ejca.2006.01.029

Cited by 106 publications

(98 citation statements)

References 16 publications

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“…4 Moreover, several authors have reported that the return of serum testosterone level (T) to normal range during intermittent androgen deprivation is associated with a significant improvement of general well-being, and urinary (UF) and sexual function (SF). [5][6][7] In particular, QOL benefits in the off-treatment phase are shown by a shift toward baseline levels in the scales depicting physical and work functions, urgency, nocturia, impotence and sexual performance. 8 Furthermore, hypogonadism is very common in elderly men and men who have PCa: the symptoms of hypogonadism, such as depression, erectile dysfunction (ED) and lower urinary tract symptoms, can significantly impair a man's QOL.…”

Section: Introductionmentioning

confidence: 99%

Influence of serum testosterone on urinary continence and sexual activity in patients undergoing radical prostatectomy for clinically localized prostate cancer

Gacci

Corona

Apolone

et al. 2010

Prostate Cancer Prostatic Dis

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The aim of the present study was to evaluate how serum testosterone level (T) can affect urinary continence and erectile function in patients undergoing radical prostatectomy (RP). We included 257 patients with clinically localized prostate cancer, those who had filled out preoperative quality of life questionnaires (University of California, Los Angeles Prostate Cancer Index, International Index of Erectile Function (IIEF)), and those who had T and total PSA sampled the day before surgery. We calculated correlations between T and age, body mass index (BMI), PSA, urinary function or bother (UF, UB) and sexual function or bother (SF, SB) and IIEF-5 in the whole population and in sub-populations with normal (X10.4 nmol l À1 ) and low (o10.4 ng ml À1 ) T using Pearson's and Spearman's correlation coefficients. We evaluated differences in these parameters between patients with low and normal T using the unpaired samples t-test and Mann-Whitney test, and finally the correlation between UF and SF, UB and SB, and between PSA and T in the overall population, and separately in patients with low and normal T using the Pearson's correlation coefficient. Mean preoperative T was 13.5 nmol l À1 and 23.7% of patients presented a low T. Mean age, mean BMI and mean preoperative total PSA at RP were 64.3 years, 25.9 kg m À2 and 9.0 ng ml À1 , respectively. BMI was negatively correlated with T in the overall population (r ¼ À0.266; P ¼ 0.02); moreover, patients with normal T presented lower BMI compared with patients with low T (25.7 vs 27.6: P ¼ 0.02). We found a significant correlation between SF scores and T in patients with normal T (r ¼ 0.1777: P ¼ 0.05). SF was significantly higher in patients with normal T compared with those with low T (74.8 vs 64.8: P ¼ 0.05). Furthermore, UF and UB were significantly correlated with SF (r ¼ 0.2544: Po0.01) and SB (r ¼ 0.2512: P ¼ 0.01), respectively, in men with normal T. Serum T was significantly correlated with PSA in men with low T (r ¼ 0.3874: P ¼ 0.0029), whereas this correlation was missed in the whole population and in men with normal T. The correlation between preoperative PSA and T in men with low T is in agreement with the 'saturation' model proposed by Morgentaler. The correlation between basal T and preoperative erectile function and urinary continence underlines the importance of assessing T before RP.

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Section: Introductionmentioning

confidence: 99%

Influence of serum testosterone on urinary continence and sexual activity in patients undergoing radical prostatectomy for clinically localized prostate cancer

Gacci

Corona

Apolone

et al. 2010

Prostate Cancer Prostatic Dis

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“…[50][51][52] Conversely, intermittent androgen suppression in men with prostate cancer resulted in improvements in health-related quality of life during the off-treatment period, in parallel with the recovery of testosterone levels. 53 In the absence of prostate cancer and androgen deprivation therapy, lower total or bioavailable testosterone levels are associated with sarcopenia, lower muscle strength, poorer physical performance and increased risk of falls in older men. [54][55][56][57][58] In men aged X65 years, low total testosterone levels (o6.94 nmol l À1 ) were associated with increased prevalence of osteoporosis defined as bone mineral density T-score of pÀ2.5 at either hip or femoral neck and a higher incidence of rapid hip-bone loss.…”

Section: Testosterone General Health and Quality Of Life In Aging Menmentioning

confidence: 99%

Are declining testosterone levels a major risk factor for ill-health in aging men?

Yeap

2008

Int J Impot Res

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As men grow older, testosterone levels fall, with a steeper decline in unbound or free testosterone compared with total testosterone concentrations. Lower testosterone levels have been associated with poorer cognitive function, and with impaired general and sexual health in aging men. Recently, lower testosterone levels have been linked with metabolic syndrome and type II diabetes, both conditions associated with cardiovascular disease, and shown to predict higher overall and cardiovascular-related mortality in middle-aged and older men. However, reverse causation has to be considered, as systemic illness may result in reduced testosterone levels. Thus, the strength of these associations and the likely direction of causation need to be carefully considered. Furthermore, these conditions may overlap, for example aging, lower testosterone levels, erectile dysfunction and cardiovascular disease are interrelated. Cross-sectional and longitudinal observational studies may be informative. However, ultimately randomized controlled trials of testosterone therapy are needed to clarify its role in the maintenance of general and sexual health in aging men. Testosterone therapy should be considered in hypogonadal men who meet rigorous criteria for the diagnosis of androgen deficiency. Additional consideration should be given to designing and testing interventions that may prevent or ameliorate the age-related decline in testosterone levels in men.

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“…Regardless of the treatment option, prostate cancer survivors (patients) often experience a very high rate of morbidity caused by the cancer and treatments, particularly ADT. Examples of these sideeffects include significant reductions in various aspects of quality of life, with this often becoming more pronounced over time or with additional treatment 8,9 . Another common symptom that prostate cancer patients experience is fatigue [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review

Keogh

MacLeod

2012

Journal of Pain and Symptom Management

181

167

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Context: Prostate cancer patients, especially those on androgen deprivation therapy (ADT) experience many symptoms that make it difficult to maintain their independence and quality of life. As ADT act via reducing testosterone production, exercise may offset many of the ADT side-effects and that of the cancer itself. Objectives: This article sought to conduct a systematic review of the literature on whether exercise could reduce symptoms and improve quality of life for prostate cancer patients. Methods: Using relevant databases and keywords, 12 training studies were found meeting the inclusion and exclusion criteria. Results: Grade A level evidence was observed for the benefits of exercise in improving muscular endurance, aerobic endurance and overall quality of life as well as reducing fatigue in prostate cancer patients. Grade B evidence also suggested that exercise may improve prostate cancer patients' muscle mass, muscular strength, functional performance (walking and sit to stand speed) as well as health-related, social and physical quality of life. These effects appeared greater for group-rather than home-based exercise; especially if these programs including resistance training. Conclusion: It is recommended that most prostate cancer patients be encouraged to exercise regularly by their clinicians and significant others. Where possible, this exercise should be group-based and include some resistance training. Future research in this area should directly compare group-and home-based as well as resistance, aerobic and combined resistance and aerobic training to better elucidate the most effective forms of exercise for this population and what factors affect initiation and adherence to such programs.

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Adverse effects to quality of life arising from treatment can recover with intermittent androgen suppression in men with prostate cancer

Cited by 106 publications

References 16 publications

Influence of serum testosterone on urinary continence and sexual activity in patients undergoing radical prostatectomy for clinically localized prostate cancer

Influence of serum testosterone on urinary continence and sexual activity in patients undergoing radical prostatectomy for clinically localized prostate cancer

Are declining testosterone levels a major risk factor for ill-health in aging men?

Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review

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