Impact of locally advanced or metastatic prostate cancer on the quality of life

Integration of Patient Reported Outcomes in Drug Development in Genitourinary Cancers

PURPOSE OF REVIEW

Patient reported outcomes (PROs) are increasingly utilized in cancer drug development, and are of particular importance in genitourinary cancers due to symptom burden, multiple treatment options with similar efficacy, and often prolonged duration of disease. Here we review current data and perspectives related to use of PROs in drug development for genitourinary cancers, including insights on the regulatory process for drug approval.

RECENT FINDINGS

The FDA is committed to incorporating PRO data into the regulatory process for development and approval of new cancer drugs, but challenges exist due to lack of standardization of PRO instrument choice and analytic approach, missing data, and difficulty isolating treatment effect from disease-related effects. We review guidance for standardization of PRO methodology that is nonetheless tailored to disease state and anticipated effects of treatment. PRO and efficacy data should be simultaneously analyzed and reported for best clinical practice. Multiple disease-specific PRO instruments exist for genitourinary cancers. While clinicians, researchers, and regulatory bodies alike recognize the importance of PROs in cancer drug development, challenges remain regarding implementation of best practices.

Health-related quality of life of exposed versus non-exposed androgen deprivation therapy patients with prostate cancer: a cross-sectional study

Background The survival rate of prostate cancer is relatively higher than other cancers, therefore, the health-related quality of life (HRQoL) becomes a critical issue for the patients. There are limited quality of life data evaluating the difference between androgen deprivation therapy and non-androgen deprivation therapy. Objective To evaluate the HRQoL among prostate cancer patients with androgen deprivation therapy and non-androgen deprivation therapy in an Asian population. Setting The study was conducted at the urology outpatient department in a medical center and a regional hospital in southern Taiwan. Methods We collected the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Quality of Life Questionnaire-Prostate (QLQ-PR25) among prostate cancer patients with and without androgen deprivation therapy from December 2017 to June 2018. The androgen deprivation therapy subjects in this study were using goserelin, leuprolide, degarelix, bicalutamide, enzalutamide, cyproterone, and abiraterone. The non-androgen deprivation therapy subjects were only receiving radiation therapy or radical prostatectomy. To investigate the determinants of HRQoL between androgen deprivation therapy and non-androgen deprivation therapy, multiple linear regression was used. Main outcomes measures The scores of EORTC QLQ-C30 and QLQ-PR25. Results In total, 182 subjects participated in the study of which 116 (63.74%) were in androgen deprivation therapy user group with a mean age (± SD, standard deviation) of 75.94 years (± 8.31), and 66 (36.26%) subjects were in non-androgen deprivation therapy user group with a mean age of 70.6 years (± 7.1). androgen deprivation therapy users' quality of life was significantly lower than non-androgen deprivation therapy users (72.1 ± 19.3 vs. 77.8 ± 16.6, p = 0.0493). Conclusions The quality of life of patients with all-stages prostate cancer differs significantly between androgen deprivation therapy users and non-androgen deprivation therapy users. The HRQoL for androgen deprivation therapy users is worse than for the non-androgen deprivation therapy users. Additionally, the symptoms are the key determinants of the quality of life.

Depression promotes prostate cancer invasion and metastasis via a sympathetic-cAMP-FAK signaling pathway

Depression drives cancer progression and induces poor clinical outcome. However, the mechanisms underlying depression and cancer outcomes are unclear. In this work, we investigated 98 prostate cancer patients and found that patients with high score of psychological depression were correlated with tumor invasion and metastasis. We found focal adhesion kinase (FAK) was increased in cancer patients with metastatic features and high score of depression. FAK knockdown completely blocked depression-promoted tumor invasion in orthotopic transplantation tumors. In Hi-myc mice and a murine model of depression, sympathetic activation was detected in the prostate tissue. Further we showed that FAK activation was dependent on a cAMP-PKA signaling pathway. Our results demonstrated that the activation of a sympathetic-FAK signaling pathway in prostate cancer patients with high degrees of depression facilitates tumor invasion. We suggest that blocking β2AR with propranolol or inhibiting FAK activation with PF562 271 may be novel strategies for depressed patients with invasive prostate cancer.