What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product

Abstract

BackgroundAndrogen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients’ quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education.MethodsInternational respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product).ResultsNo differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists.ConclusionsADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.

Impact of neoadjuvant relugolix on patient-reported sexual function and bother

“…Bother has been found to be more pronounced in cases of short-term ADT, particularly among younger patients and individuals with higher baseline sexual function ( 20 , 9 . 22 ). Given that older patients are more likely to exhibit diminished sexual function at baseline, the effects of ADT on intimacy may be less impactful, resulting in decreased bother.…”

“…discovered that advanced prostate cancer patients are less likely to receive counseling on sexual dysfunction and identified a lack of consensus over the responsibility of UK-based physicians in managing sexual impairment ( 21 ). Nevertheless, there is inconsistency in referring patients to sex therapists and psychosexual counseling ( 22 ).…”

Temporal trends in cardiovascular burden among patients with prostate cancer receiving androgen deprivation therapy: a population-based cohort study

“…It was possible that similar changes in the selection of patients for ADT have influenced the cardiovascular outcomes. This was especially relevant since the use of ADT is heavily dependent on patient preferences even within guidelines [ 3 , 22 ], with studies having shown significant variations in practice [ 23 , 24 ]. It may thus be reasonable to speculate that changes in patient preferences outside the scope of this study may have contributed to the differences in cardiovascular burden and outcomes, either directly or by influencing patient selection for ADT.…”

Gynaecomastie en mastodynie als gevolg van androgeendeprivatietherapie bij prostaatkanker

“…Uit ander onderzoek is gebleken dat 50% van de mannen niet op de hoogte was van de mogelijkheid van gynaecomastie [15]. In vier artikelen wordt beschreven dat patiënten en partners slecht zijn geïnformeerd over de bijwerkingen van LHRHa [5,6,15,16]. Dit lijkt dus niet op te gaan voor de onderzochte populatie in het RdGG.…”

“…Waarschijnlijk zijn onze gegevens niet generaliseerbaar naar landen buiten Nederland, omdat er verband blijkt te zijn tussen ras, klimatologische en geografische aspecten en het behandelen van gynaecomastie ten gevolge van ADT [16]. In landen met een Artikel laag bruto binnenlands product worden mannelijkheid, mannelijke identiteit en seksuele uitstraling begevonden, waardoor bij de behandeling met ADT gynaecomastie meer aandacht krijgt [16]. In landen met een hoog bruto binnenlands product wordt men eerder gescreend op en behandeld voor prostaatkanker, waardoor de overleving toeneemt en men langer last kan hebben van de bijwerking gynaecomastie.…”