Background
Androgen deprivation therapy (ADT), an effective treatment for prostate cancer has adverse effects consequent to severe hypogonadism. Effects on quality of life (QoL) are poorly characterised, due to limited evidence from controlled prospective studies. We hypothesised that men undergoing ADT will have decreased QoL in all domains.
Aim
To assess changes in QoL and to investigate contributing factors in men undergoing ADT.
Methods
Sixty-three men with prostate cancer were evaluated in a prospective, 12 month case-control study including 34 cases newly commencing ADT and 29 prostate cancer controls not receiving ADT, matched for age and radiotherapy. Participants performed the Short Form-12 (SF-12) (physical and mental components, and Aging Males’ Symptoms Score (AMSS) (somatic, sexual and psychological components) QoL questionnaires at 0, 6 and 12 months. Using a mixed model, the mean adjusted differences (MAD) in QoL scores between groups from 0 to 12 months are reported.
Results
QoL as measured by SF-12 showed decrement in the physical component for the ADT group compared with controls (MAD 3.56 [0.45, 6.68] p=0.026) but there was no significant difference in the mental component (MAD 1.22 [-2.23, 4.67], p=0.49). QoL as measured by total AMSS was worse in the ADT group compared with controls (MAD -9.48 [-13.04, -5.91] p<0.001). Deficits were seen in the somatic (p<0.001), sexual (p<0.001) and psychological components (p=0.044). The decrease in QoL by AMSS was related to increase in hot flushes (p=0.002) but unrelated to haemoglobin levels (p=0.45).
Conclusions
Men receiving ADT have decrements in somatic and sexual aspects of QoL exceeding the impact of the cancer diagnosis and radiotherapy alone. Changes in psychological well-being are less consistent, perhaps due to insensitivity of questionnaires to detect small changes. The observed deficits should be useful in patient counselling and implementation of targeted strategies to mitigate adverse effects of ADT.