ADT affects men’s mental, emotional well-being

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 2 years after treatment, a recent study found.

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.

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.

For the current study, which is scheduled to be published in the Journal of Urology in April, the 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. Over 3,000 men completed a pretreatment and at least one post-treatment quality of life assessment checklist.

The authors focused on men newly diagnosed with localized 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% with combination treatment, and 5% with 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 improved scores,” explained lead investigator Clint Cary, MD, MPH, of the University of California, San Francisco.

Dr. Cary said he recommends that patients be 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 concluded.

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