March 3, 2007

Impact Of Androgen Deprivation Therapy On Physical And Cognitive Function, As Well As Quality Of Life Of Patients With Nonmetastatic Prostate Cancer Androgen deprivation therapy (ADT) is given for significantly longer periods of time, with patients being treated for biochemical failure in the absence of known skeletal metastasis. Dr. Joly and associates evaluated the physical and cognitive effects on patients receiving ADT and report their findings in the December 2006 issue of the Journal of Urology.

Between 2003 and 2004 57 eligible men treated with ADT for at least 3 months for localized CaP, as adjuvant therapy, or for biochemical failure after primary therapy were included in the study. Of these, 30 received ADT as adjuvant treatment following radical prostatectomy (n=7) or radiotherapy (n=23), and 27 for a rising PSA. An LHRH analogue was given alone in 48 men (84%) and 9 received maximal ADT. The median duration of ADT was 1.8 years. An age-matched control group of men without CaP was included in the study.

A physical test, the 6MWT was used to reflect the functional exercise level for daily physical activities. Quality of life questionnaires were used for fatigue and cognitive assessments. Neuropsychological tests also screened for cognitive impairment.

More controls were found to have social activities compared to patients (92% vs. 77%). No differences in previous medical or psychiatric history were found. Patients had lower median hemoglobin and serum testosterone levels. No difference in cognitive, physical and QoL measures was found between patient receiving ADT as adjuvant therapy and those receiving it for increasing PSA. Duration of ADT did not correlate between the different measures. Overall functioning was high in both controls and patients without statistically differences in any of the measures of physical function. Furthermore, there was no difference in the incidence or severity of cognitive dysfunction between patients and controls.

Fatigue was reported by 14% of patients compared to 4% of controls. Depression was also not noted with 89% of patients and 98% in the normal range. Loss of energy by one measure was reported by 36% of patients and 16% of controls, but was not associated with hemoglobin or testosterone levels. Over the relatively short treatment period reported, significant physical and cognitive affects of ADT were not noted.

JolyВ F, AlibhaiВ SMH, GalicaВ J, ParkВ A, YiВ QL, WagnerВ L, TannockВ IF
J Urol 2006; 176(6):2443-47.

Reviewed by Contributing Editor Christopher P. Evans, MD

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