Androgen deprivation therapy's impact on the mood of prostate cancer patients as perceived by patients and the partners of patients

New Horizons: Gonadotropin-Releasing Hormone and Cognition

Pulsatile secretion of gonadotropin-releasing hormone (GnRH) is essential for activating and maintaining the function of the hypothalamic-pituitary-gonadal axis, which controls the onset of puberty and fertility. Two recent studies suggest that, in addition to controlling reproduction, the neurons in the brain that produce GnRH are also involved in the control of postnatal brain maturation, odor discrimination, and adult cognition. This review will summarize the development and establishment of the GnRH system, with particular attention to the importance of its first postnatal activation, a phenomenon known as minipuberty, for later reproductive and nonreproductive functions. In addition, we will discuss the beneficial effects of restoring physiological (ie, pulsatile) GnRH levels on olfactory and cognitive alterations in preclinical Down syndrome and Alzheimer disease models, as well as the potential risks associated with long-term continuous (ie, nonphysiological) GnRH administration in certain disorders. Finally, this review addresses the intriguing possibility that pulsatile GnRH therapy may hold therapeutic potential for the management of some neurodevelopmental cognitive disorders and pathological aging in elderly people.

A role for GnRH in olfaction and cognition: Implications for veterinary medicine

Pulsatile secretion of gonadotropin-releasing hormone (GnRH) is essential for the activation and maintenance of the function of the hypothalamic-pituitary-gonadal (HPG) axis, which controls the onset of puberty and fertility. Two provocative recent studies suggest that, in addition to control reproduction, the neurons in the brain that produce GnRH are also involved in the control postnatal brain maturation, odour discrimination and adult cognition. Long-acting GnRH antagonists and agonists are commonly used to control fertility and behaviour in veterinary medicine, primarily in males. This review puts into perspective the potential risks of these androgen deprivation therapies and immunization on olfactory and cognitive performances and well-aging in domestic animals, including pets. We will also discuss the results reporting beneficial effects of pharmacological interventions restoring physiological GnRH levels on olfactory and cognitive alterations in preclinical models of Alzheimer's disease, which shares many pathophysiological and behavioural hallmarks with canine cognitive dysfunction. These novel findings raise the intriguing possibility that pulsatile GnRH therapy holds therapeutic potential for the management of this behavioural syndrome affecting older dogs.

Study on the Conduction Analysis and Blocking Intervention Scheme of Emotional Disorders between Cancer Patients and Their Families

Objective

To analyze the transmission and blocking intervention scheme of emotional disorders between cancer patients and their families.

Methods

About 150 patients with cancer and 150 family members with mood disorders treated in a tertiary hospital in North China from March 2021 to Octobor2021 were enrolled. The patients were randomly assigned into control group and study group. The control group received routine intervention, and the study group received the diagnosis, intervention, and treatment strategies of doctor-patient-affective disorder. The factors related to the transmission of emotional disorders between cancer patients and their families were analyzed, and the alterations of anxiety, depression, social support, and satisfaction of the two groups were compared under different blocking intervention schemes.

Results

(1) Univariate analysis indicated that there were significant differences in family age, family income, sex, location of tumor, course of disease, TNM stage, somatic symptoms, and the incidence of anxiety and depression. There exhibited no significant difference between the gender of the family, the years of education of the family, the occupational status of the family, the relationship between the family and the patient, the mode of payment of the patient's medical expenses, the age of the patient, the mode of treatment of the patient, the degree of knowledge of the disease, and the incidence of anxiety and depression (P > 0.05). The anxiety and depression status of relatives were taken as dependent variables, and the age of family members, family income status, sex of patients, location of tumor, course of disease, TNM stage, and physical symptoms of patients were taken as independent variables, and the data were analyzed by Logistic regression analysis. Logistic regression analysis indicated that family income, tumor location, disease course, TNM stage, and somatic symptoms were the risk factors of anxiety and depression in relatives. (2) Comparison of social support status and intergroup, the objective support, subjective support, support utilization, and total score of social support in the study group were higher compared to the control group. In terms of the depression score before intervention, there exhibited no significant difference (P > 0.05), but after intervention, the depression score of the two groups decreased, and the depression score of the study group was lower compared to the control group before intervention, 1 week, 2 weeks, 3 weeks, and 4 weeks after intervention (P < 0.05). In terms of the anxiety score before intervention, there exhibited no significant difference (P > 0.05), but after intervention, the anxiety score of the two groups decreased, and the anxiety score of the study group was lower compared to the control group before intervention, 1 week, 2 weeks, 3 weeks, and 4 weeks after intervention (P < 0.05). Comparison of the satisfaction between the two groups and the study group was very satisfied in 56 cases, satisfactory in 14 cases, and general in 5 cases, and the satisfaction rate was 100.00%. The control group was very satisfied in 35 cases, satisfactory in 23 cases, general in 12 cases, and dissatisfied in 5 cases, and the satisfaction rate was 93.33%. The satisfaction of the study group was higher compared to the control group (P < 0.05).

Conclusion

Family income, tumor location, course of disease, TNM stage, and somatic symptoms are the risk factors of anxiety and depression in relatives. After establishing the diagnosis, intervention and treatment strategies of doctor-patient-affective disorder, the emotional disorder of family members of cancer patients, is significantly promoted, and the intervention satisfaction is high, so the scheme is worth promoting.

The psychological impact of prostate cancer after treatment: a critical review of the literature

Aim:

This critical review of the literature seeks to understand the psychological impact that treatment interventions may have on prostate cancer (PC) survivors.

Materials and Methods:

A literature search was conducted using databases of peer-reviewed literature. The search terms used were devised using the building-blocks technique to divide the query into facets. The articles were manually assessed for relevance and appraised using the relevant Critical Appraisal Skills Programme (CASP) tool. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence (NICE) website. This process resulted in a total of 12 sources being included in the critical review.

Results:

The key themes that arose from the review were masculinity, depression, anxiety and psychological implications related to sexual functioning. Psychological impact varies on an individual basis and is influenced by the quality of a patient’s experience during and after treatment in relation to sufficient information giving and support.

Findings:

Open communication should be encouraged by healthcare professionals to assess patient mental wellbeing. The extent of psychological impact varies on an individual basis; however, there are predictive factors that can make an individual more at risk of being affected psychologically post-PC treatment.

Sexual Motivation and Sexual Reward in Male Rats are Attenuated by the Gonadotropin-Releasing Hormone Receptor Antagonist Degarelix

BACKGROUND

Preclinical studies that have examined the effects of androgen deprivation therapies (ADTs) on sexual outcomes have either relied on a surgical castration model of ADTs or have largely focused on consummatory sexual behaviors.

AIM

The aim of this study was to examine the effects of a single administration of the gonadotropin-releasing hormone receptor antagonist, degarelix, on sexual incentive motivation (SIM), sexual reward, consummatory sexual behaviors, anxiety-like behavior, and androgen receptor signaling in male rats, and to determine if sexual stimulation attenuates the effects of degarelix on SIM.

METHODS

Male rats were treated with degarelix, or vehicle, and half of the rats in each condition were briefly exposed to a sexually receptive female immediately before SIM trials (experiment 1). Rats treated with degarelix or vehicle were also given a sex-conditioned place preference test (experiment 2A), weekly mating tests (experiment 2B), and an elevated zero maze test (experiment 3). Androgen-sensitive tissues were excised upon completion of testing.

OUTCOMES

SIM was indicated by the percentage of time spent near a sexually receptive female on the SIM tests. The percentage of time spent in the chamber of a conditioned place preference maze associated with sexual experience was indicative of sexual reward. The percentage of trials in which a mount, intromission, and ejaculation occurred was indicative of copulatory ability. Sexual performance was characterized by the average latencies to first exhibit these behaviors, as well as the average frequency of these behaviors. Anxiety-like behavior was indicated by the percentage of time in the open zones of an elevated zero maze. Relative weights of the seminal vesicles and bulbourethral glands were used to quantify androgen activity.

RESULTS

Rats treated with degarelix exhibited lower levels of SIM. In rats treated with degarelix, contact with a female immediately before SIM testing increased activity, but not SIM. Treatment with degarelix reduced the rewarding aspects of sexual behavior, as well as most aspects of copulatory ability and sexual performance. Degarelix treatment reduced androgen signaling, but did not impact anxiety-like behavior.

CLINICAL IMPLICATIONS

The behavioral side effects associated with the use of degarelix may be restricted to sexual behaviors.

STRENGTHS & LIMITATIONS

Strengths include the objective measurement of sexual behaviors. The study is limited in that only one ADT was examined.

CONCLUSION

These findings serve as an extension of previous preclinical studies as they indicate that gonadotropin-releasing hormone receptor antagonism in male rats also attenuates sexual motivation and sexual reward, in addition to copulatory ability and sexual performance. Hawley WR, Kapp LE, Green PA, et al. Sexual Motivation and Reward in Male Rats are Attenuated by the Gonadotropin-Releasing Hormone Receptor Antagonist Degarelix. J Sex Med 2021;18:240-255.

Androgen deprivation therapy and side effects: are GnRH antagonists safer?

Androgen deprivation therapy (ADT) with gonadotropin-releasing hormone (GnRH) agonists and antagonists is the mainstay of advanced prostate cancer treatment. Both drug classes decrease levels of luteinizing hormone and follicle-stimulating hormones (FSH), thereby lowering testosterone to castrate levels. This is associated with adverse events (AEs), including cardiovascular (CV) disorders, bone fractures, metabolic dysfunction, and impaired cognitive function. This literature review discusses these AEs, with a focus on CV and bone-related events. A hypothesis-generating meta-analysis of six clinical trials showed a potentially increased risk for CV disorders with GnRH agonists versus the GnRH antagonist degarelix. While no study has directly compared GnRH agonists versus antagonists with a primary CV outcome, one hypothesis for this observation is that GnRH agonists lead to initial surges in FSH that may negatively impact CV health, whereas antagonists do not. GnRH agonists are associated with metabolic and cognitive AEs and while data are lacking for GnRH antagonists, no differences in risk are predicted. Other common AEs with ADT include injection site reactions, which are much more common with degarelix than with GnRH agonists, which may reflect differing administration and injection techniques. Future studies are needed to further evaluate and compare the safety profiles of GnRH agonists and antagonists, especially in patients with pre-existing CV disease and other co-morbidities. Physicians should carefully evaluate benefits and risks when prescribing ADT and ensure that side effects are well managed.

Mood, sexuality, and relational intimacy after starting androgen deprivation therapy: implications for couples

BACKGROUND

Patients on androgen deprivation therapy (ADT), a common treatment for prostate cancer, report significant declines in quality of life and detrimental impact on their intimate relationships. ADT depresses a man's testosterone to castrate levels, leading to declines in sexual function, and changes in mood. These changes can have profound impact on couples' intimate relationships.

METHOD

Patients undergoing ADT, and their consenting partners, were followed on a variety of outcomes relating to mood, sexual changes, and relational intimacy. Participants were assessed at baseline, 3 months, and 6 months. Changes in these three domains are documented. A dyadic analysis was conducted on the primary outcome of relational intimacy in order to assess the role of changes in mood and various aspects of sexuality on couples' intimate relationships.

RESULTS

Declines were observed in the first 6 months on ADT for sexual function, sexual frequency, and relational intimacy. Sexual bother increased within the first 3 months on ADT. No changes in mood were observed. Dyadic analysis revealed important effects on couples' reports of relational intimacy. (A) Patient and partner ratings of emotional intimacy were higher when partners better understood the patients' mood state. (B) Patient and partner ratings of sexual intimacy were higher when couples were more sexually active.

CONCLUSIONS

The current study confirms that patients experience reduced sexuality and relational intimacy during the first 6 months on ADT. Specific facets of relational intimacy are improved with increased sexual activity and also when partners recognize the emotional changes that patients are experiencing.

Androgen Deprivation Alters Attention to Sexually Provocative Visual Stimuli in Elderly Men

INTRODUCTION

Testosterone is known to regulate male sexual interest, but the exact way that androgens influence men's sexual cognition remains unclear.

AIM

To investigate the influence of androgen deprivation (AD) on visual responses to sexually suggestive stimuli in men treated for prostate cancer with AD therapy.

METHODS

Patients with AD-treated prostate cancer, patients with prostate cancer not on AD therapy, and age-matched healthy control participants were exposed to images of male and female runway models fully or minimally clothed. Eye tracking was used to compare looking behavior among groups.

MAIN OUTCOME MEASURES

Proportion of fixations on fully clothed vs minimally clothed models and proportion of fixations on target areas of interest (ie, legs, chest, pelvis, and face) of fully clothed and minimally clothed models were analyzed and compared among groups.

RESULTS

Although men not on AD exhibited a larger proportion of fixations on the minimally clothed compared with the fully clothed images, there was no difference between the 2 image types for men on AD. This was true regardless of whether the images depicted male or female models. Groups did not differ in their fixations to target areas of interest.

CONCLUSION

These results suggest that testosterone can influence men's visual attention to sexual stimuli; specifically, AD can attenuate the time spent fixated on sexualized targets. Palmer-Hague JL, Tsang V, Skead C, et al. Androgen Deprivation Alters Attention to Sexually Provocative Visual Stimuli in Elderly Men. Sex Med 2017;5:e245-e254.

Association of androgen deprivation therapy and depression in the treatment of prostate cancer: A systematic review and meta-analysis

BACKGROUND

There is increasing evidence that androgen deprivation therapy (ADT) may be associated with depression. Existing studies have shown conflicting results.

METHODS

PubMed, Web of Science, Embase, and PsycINFO were queried on April 5, 2017. Eligible studies were in English and reported depression among individuals with prostate cancer exposed to a course of ADT vs. a lesser-exposed group (e.g., any-ADT vs. no ADT and continuous ADT vs. intermittent ADT). We used the MOOSE statement guidelines and the Cochrane Review Group's data extraction template. Study quality was evaluated by Newcastle-Ottawa Scale criteria. We conducted a random-effects meta-analysis to calculate summary statistic risk ratios (RRs) and 95% CIs. Heterogeneity was quantified using the I² statistic and prespecified subgroup analysis. Small study effects were evaluated using Begg and Egger statistics.

RESULTS

A total of 1,128 studies were initially identified and evaluated. A meta-analysis of 18 studies among 168,756 individuals found that ADT use conferred a 41% increased risk of depression (RR = 1.41; 95% CI: 1.18-1.70; P<0.001). We found a consistent strong statistically significant association when limiting our analysis to studies in localized disease (RR = 1.85; 95% CI: 1.20-2.85; P = 0.005) and those using a clinical diagnosis of depression (RR = 1.19; 95% CI: 1.08-1.32; P = 0.001). We did not find an association for continuous ADT with depression risk compared to intermittent ADT (RR = 1.00; 95% CI: 0.50-1.99; P = 0.992). There was no statistically significant evidence of small study effects. Statistically significant heterogeneity in the full analysis (I² = 80%; 95% CI: 69-87; P<0.001) resolved when examining studies using a clinical diagnosis of depression (I² = 16%; 95% CI: 0-60; P = 0.310).

CONCLUSION

The currently available evidence suggests that ADT in the treatment of prostate cancer is associated with an increased risk of depression.

The perspective of prostate cancer patients and patients' partners on the psychological burden of androgen deprivation and the dyadic adjustment of prostate cancer couples

OBJECTIVE

Prostate cancer and its treatments, particularly androgen deprivation therapy (ADT), affect both patients and partners. This study assessed how prostate cancer treatment type, patient mood, and sexual function related to dyadic adjustment from patient and partner perspectives.

METHODS

Men with prostate cancer (n = 206) and partners of men with prostate cancer (n = 66) completed an online survey assessing the patients' mood (profile of mood states short form), their dyadic adjustment (dyadic adjustment scale), and sexual function (expanded prostate cancer index composite).

RESULTS

Analyses of covariance found that men on ADT reported better dyadic adjustment compared with men not on ADT. Erectile dysfunction was high for all patients, but a multivariate analysis of variance found that those on ADT experienced greater bother at loss of sexual function than patients not on ADT, suggesting that loss of libido when on ADT does not mitigate the psychological distress associated with loss of erections. In a multiple linear regression, patients' mood predicted their dyadic adjustment, such that worse mood was related to worse dyadic adjustment. However, more bother with patients' overall sexual function predicted lower relationship scores for the patients, while the patients' lack of sexual desire predicted lower dyadic adjustment for partners.

CONCLUSIONS

Both patients and partners are impacted by the prostate cancer treatment effects on patients' psychological and sexual function. Our data help clarify the way that prostate cancer treatments can affect relationships and that loss of libido on ADT does not attenuate distress about erectile dysfunction. Understanding these changes may help patients and partners maintain a co-supportive relationship. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.