A new study published in the Journal of Urology® reports that prostate cancer patients treated with androgen deprivation therapy (ADT) experienced changes in mental and emotional well-being during treatment, although there was no meaningful decline in emotional quality of life two years after treatment.
Investigators at the University of California-San Francisco recommend counseling men about the potential adverse effects of ADT as well as the interventions to improve mental and emotional health such as exercise programs and diet.
Nearly 240,000 men were expected to be diagnosed with prostate cancer in the United States in 2013, with around 30,000 deaths. Treatment for prostate cancer is associated with significant physical side-effects. Some of these patients are likely to experience more adverse side-effects and complications from the treatment than from the cancer itself. Earlier studies have suggested that treatment may also affect mental and emotional health.
ADT, which suppresses the production of testosterone by either medical or surgical castration, remains the gold standard for treating advanced prostate cancer, either alone or with radiation therapy. Benefits include reduction of tumor burden, delayed cancer progression, and overall improvement in survival in some cases. However, ADT has a number of physical side-effects, including hot flashes, decreased libido, fatigue, decreased bone and muscle mass, increased total body fat content, and possible harmful cardiovascular effects.
Previous studies have reported cognitive and affective symptoms following ADT, particularly in the elderly. Symptoms include emotional upset (tearfulness, irritability, and anger), decreased motivation, hopelessness, and cognitive interruptions in attention, memory, and visual processing. Some studies have linked ADT use to depression, although it is not clear whether such effects are a direct consequence of ADT itself or perhaps associated with age, comorbidities, hot flashes, fatigue, and insomnia.
The current authors evaluated the effects of ADT on mental and emotional well-being in men diagnosed with localized prostate cancer using data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) registry, which consists of data from largely community-based practices across the United States. Over 3,000 men completed a pretreatment and at least one posttreatment quality of life assessment checklist.
The authors focused on men newly diagnosed with localized (non-metastatic) prostate cancer in 1995-2011 and treated with radical prostatectomy, brachytherapy, radiation therapy, or primary androgen deprivation therapy (PADT). Of men included in the study 75% were treated with local therapy, 20% combination treatment, and five percent PADT. Among men in the PADT group, 84% were treated with luteinizing hormone-releasing hormone agonist monotherapy and 16% received combined androgen blockade.
Approximately 36% of patients reported some type of mental impairment at pretreatment evaluation, including depression, insomnia, confusion, poor concentration, sleep disturbances, nervousness, or poor memory. There were no overall differences in rates of mental health symptoms at diagnosis among treatment groups, although 18% of the PADT group reported poorer memory compared to 12% in the local group and 15% in the combination group.
Analysis demonstrated that exposure to ADT was associated with significant changes in mental and emotional well-being but did not result in clinically meaningful declines at 24 months. "These results could be related to men in the ADT group adapting to their symptoms over time, thus reporting improves scores," explains lead investigator Clint Cary, MD, MPH, of the Department of Urology at the University of California-San Francisco.
The most pronounced effect of ADT was on vitality. "This result corroborates other studies documenting fatigue among the most commonly reported side effects of ADT," says Cary. "It is not clear though whether the fatigue is a direct effect of ADT itself or a consequence of the physical side effects of ADT, such as sleep disturbances or hot flashes."
Cary recommends that patients are counseled on possible ADT-related quality of life changes, as well as ways to minimize these changes before treatment for prostate cancer. "All patients should be well informed about the potential adverse effects of ADT, and interventions to improve mental and emotional health such as exercise programs and dietary/lifestyles changes could be of particular importance," he concludes.
Linda Gruner | EurekAlert!
Multi-year study finds 'hotspots' of ammonia over world's major agricultural areas
17.03.2017 | University of Maryland
Diabetes Drug May Improve Bone Fat-induced Defects of Fracture Healing
17.03.2017 | Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
24.03.2017 | Materials Sciences
24.03.2017 | Physics and Astronomy
24.03.2017 | Physics and Astronomy