Risk of the “Androgen Deprivation Syndrome” in Men Receiving Androgen Deprivation for Prostate Cancer

Abstract

Background: Androgen deprivation therapy for prostate cancer has been associated with a spectrum of adverse effects, such as depression, memory difficulties, and fatigue, termed the androgen deprivation syndrome. Primary care physicians providing follow-up care for men with prostate cancer will be faced with managing these effects. We therefore sought to estimate the incidence of these effects and, by using a control group, ascertain whether these effects were related to androgen deprivation itself. Methods: We assessed the risk of physician diagnoses of depression, cognitive impairment, or constitutional symptoms in Medicare data following androgen deprivation using a sample of 50 613 men with incident prostate cancer and 50 476 men without cancer, from 1992 through 1997, in the linked Surveillance, Epidemiology, and End Results-Medicare database. Cox proportional hazards regression was used to adjust for confounding variables. Results: Of men surviving at least 5 years after diagnosis, 31.3% of those receiving androgen deprivation developed at least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7% in those who did not (PϽ.001). After adjustment for variables such as comorbidity, tumor characteristics, and age, the risks associated with androgen deprivation were substantially reduced or abolished: relative risk (RR) for depression diagnosis, 1.08 (95% confidence interval [CI], 1.02-1.15); RR for cognitive impairment, 0.99 (95% CI, 0.94-1.04); and RR for constitutional symptoms, 1.17 (95% CI, 1.13-1.22). Conclusion: Depressive, cognitive, and constitutional disorders occur more commonly in patients receiving androgen deprivation, but this appears to be primarily because patients receiving androgen deprivation are older and have more comorbid conditions and more advanced cancers.

Psychological distress in men with prostate cancer receiving adjuvant androgen-deprivation therapy

“…The correlation of depression with ADT in prostate cancer patients, however, is more difficult to demonstrate because many depressive effects could plausibly occur secondary to a diagnosis of cancer and the onset of relevant symptoms. In a large-scale series of patients in the linked Surveillance, Epidemiology, and End Results-Medicare database [26] involving either metastatic or apparently disease-free patients, the risk of depression associated with androgen deprivation was substantially abolished after adjustment for variables such as comorbidity, tumor characteristics, and age. In the present study, we evaluated depression and other physical and psychological distresses contributory to depression in a consecutive series of patients who had received loco-regional treatments (radical prostatectomy and radiation therapy) for non-metastatic disease, 48% of whom were receiving ADT and 52% were under follow-up alone.…”

“…As insomnia and worsened body image perception are both notoriously linked to depression [21][22][23][24], they can concur in the development of depressive symptoms associated with low testosterone levels. These premises notwithstanding, study results on depression in prostate cancer patients undergoing ADT remain controversial: one pilot study found major depressive disorder in a high percent of prostate cancer patients under ADT [25], whereas a large population-based analysis of depressive and cognitive symptoms in patients with prostate cancer failed to show a higher prevalence of depressive symptoms in ADT treated patients vs. non-treated patients after adjusting for age, comorbidities, and disease stage [26]. The present study was designed to investigate the frequency of depression and other contributory physical and psychological distresses, such as quality of life deterioration, worsening of self body image perception, and sleep disorders, in a group of consecutive prostate cancer patients referred for ADT as adjuvant therapy after loco-regional treatment as compared with a group of prostate cancer patients referred for follow up only.…”

Complications de l’hormonothérapie anti-androgénique du cancer de la prostate

“…Les différences d'âge, l'avancement de la maladie et la présence de comorbidités peuvent expliquer en partie les variations d'ordre cognitif et émotionnel entre les hommes recevant l'HAA et ceux ne la recevant pas 25 . Cependant, les hommes atteints de cancer de la prostate sont à risque pour la dépression et le déclin cognitif.…”

Quality of life issues in men undergoing androgen deprivation therapy: a review

“…20 This syndrome is manifested in physical, social and sexual functional changes that have dramatic impact on overall and site specific QoL. The side effects of ADT also significantly affect the intimate partners of patients, who often experience more distress than the patients themselves.…”