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Shah S, Pepin A, Jatar S, Hsueh J, Gallagher L, Danner MT, Zwart A, Ayoob M, Yung TM, Kumar D, Aghdam N, Leger PD, Dawson NA, Simeng S, Collins SP. Bothersome Hot Flashes Following Neoadjuvant Androgen Deprivation Therapy and Stereotactic Body Radiotherapy for Localized Prostate Cancer. Cureus 2024; 16:e55729. [PMID: 38586683 PMCID: PMC10998655 DOI: 10.7759/cureus.55729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT) improves local cancer control in unfavorable localized prostate cancer treated with radiotherapy. ADT is known to cause hormonally related symptoms that resolve with testosterone recovery. Hot flashes are particularly burdensome. This study sought to evaluate the timeline of hot flashes following short-course ADT and stereotactic body radiotherapy (SBRT) as well as its relationship with testosterone recovery. METHODS Institutional IRB approval was obtained for this retrospective review of prospectively collected data (IRB#: 2009-510). ADT was initiated three months prior to the start of SBRT. Hot flashes were self-reported via question 13a of the Expanded Prostate Index Composite (EPIC)-26 prior to ADT initiation, the first day of robotic SBRT, and at each follow-up (one, three, six, nine, 12, 18, 24, and 36 months). The responses were grouped into three relevant categories (no problem, very small-small problem, and moderate-big problem). Scores were transformed to a 0-100 scale with higher scores reflecting less bother. Testosterone levels were measured at each follow-up. RESULTS From 2007 to 2010, 122 localized prostate cancer patients (nine low-, 64 intermediate-, and 49 high-risk according to the D'Amico classification) at a median age of 72 years (range 54.5-88.3) were treated with short course ADT (three to six months) and SBRT (35-36.25 Gy) at Georgetown University Hospital. Thirty-two percent were Black and 27% were obese. Seventy-seven percent of patients received three months of ADT. At baseline, 2% of men experienced hot flashes that were a "moderate to big problem" and that proportion peaked at the start of SBRT (45%) before returning to baseline (2%) nine months post-SBRT with a cumulative incidence of 52.4%. The median baseline EPIC-26 hot flash score of 94 declined to 50 at the start of SBRT but this returned to baseline (92) by six months post SBRT. These changes were both statistically and clinically significant (MID = 9.5083, p<0.01). Testosterone recovery (> 230 ng/dL) occurred in approximately 70% of patients by 12 months post SBRT. Resolution of hot flashes correlated with testosterone recovery. CONCLUSION Bothersome hot flashes occur in greater than 50% of men treated with neoadjuvant ADT. Resolution of hot flashes occurs in the majority of patients within one year after treatment. Reassurance of the temporary nature of hot flashes may assist in reducing patient anxiety. Measuring testosterone levels at follow-up visits may allow for anticipatory counseling that may limit the associated bother.
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Affiliation(s)
- Sarthak Shah
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Abigail Pepin
- Radiation Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia, USA
| | - Simran Jatar
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Jessica Hsueh
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Lindsey Gallagher
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Malika T Danner
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Alan Zwart
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Marilyn Ayoob
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Thomas M Yung
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Deepak Kumar
- Medicine, Biotechnology Research Institute, North Carolina Central University, Durham, USA
| | - Nima Aghdam
- Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Paul D Leger
- Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Nancy A Dawson
- Oncology, MedStar Georgetown University Hospital, Washington, USA
| | - Suy Simeng
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
| | - Sean P Collins
- Radiation Medicine, MedStar Georgetown University Hospital, Washington, USA
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Depotte L, Caroux M, Gligorov J, Canouï-Poitrine F, Belkacemi Y, De La Taille A, Tournigand C, Kempf E. Association between overweight, obesity, and quality of life of patients receiving an anticancer treatment for prostate cancer: a systematic literature review. Health Qual Life Outcomes 2023; 21:11. [PMID: 36721272 PMCID: PMC9887848 DOI: 10.1186/s12955-023-02093-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) and obesity are two ever-increasing public health issues that can independently impair the quality of life (QOL) of affected patients. Our objective was to evaluate the impact of overweight and obesity on the QOL of patients with PCa receiving an anticancer treatment. METHODS We performed a systematic review of the literature using PubMed, Embase, Cochrane Library and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search equation targeted studies that included PCa patients who had a body mass index (BMI) greater than 25 kg/m2, who were receiving anticancer therapy, and whose QOL was analyzed according to validated or non-validated scores. RESULTS Of 759 identified articles, we selected 20 studies published between 2000 and 2019 of 12,529 patients treated for PCa, including 5549 overweight or obese patients. QOL assessment was performed using nine validated scales and two non-validated questionnaires. Of seven studies on radiotherapy, six found obesity to have a negative impact on patients' QOL (especially urinary, sexual, and bowel-related QOL). Thirteen studies assessed the QOL of patients who underwent radical prostatectomy, with a BMI > 25 kg/m2 having no observed impact. In obese patients under 65 years of age and without comorbidities, nerve-sparing surgery appeared to limit the deterioration of QOL. Four studies on brachytherapy found discordant results. One study showed greater QOL impairment in obese patients receiving first-generation hormone therapy than in those with normal or decreased BMI. No study evaluated the QOL of overweight or obese patients receiving other types of systemic treatment. CONCLUSION Based on the published data, the level of evidence for an association between QOL and overweight or obesity in patients treated for PCa is not high. Prospective cohort studies including this type of patient population are warranted to answer this topical public health issue.
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Affiliation(s)
- Léonard Depotte
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor Teaching Hospital, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France
| | - Maryline Caroux
- Department of Medical Oncology, Arras Hospital, Arras, France
| | - Joseph Gligorov
- grid.50550.350000 0001 2175 4109Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Tenon Teaching Hospital, Paris, France
| | - Florence Canouï-Poitrine
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, NSERM U955, IMRB-CEpiA Team, Henri Mondor Teaching Hospital, Créteil, France
| | - Yazid Belkacemi
- grid.50550.350000 0001 2175 4109Assistance Publique – Hôpitaux de Paris, Department of Radiation Therapy, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Alexandre De La Taille
- grid.50550.350000 0001 2175 4109Assistance Publique – Hôpitaux de Paris, Department of Urology, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
| | - Christophe Tournigand
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor Teaching Hospital, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France
| | - Emmanuelle Kempf
- grid.412116.10000 0004 1799 3934Assistance Publique – Hôpitaux de Paris, Department of Medical Oncology, Henri Mondor Teaching Hospital, 1 Rue Gustave Eiffel, 94010 Créteil Cedex, France ,Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d’Informatique Médicale Et d’Ingénierie Des Connaissances Pour La E-Santé, LIMICS, Paris, France
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Sparasci D, Napoli I, Rossi L, Pereira-Mestre R, Manconi M, Treglia G, Marandino L, Ottaviano M, Turco F, Mangan D, Gillessen S, Vogl UM. Prostate Cancer and Sleep Disorders: A Systematic Review. Cancers (Basel) 2022; 14:cancers14071784. [PMID: 35406556 PMCID: PMC8997021 DOI: 10.3390/cancers14071784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Longer survival times for prostate cancer patients due to efficient treatments consisting of local radiotherapy, prostatectomy and androgen-deprivation therapy, as well as androgen-receptor-targeted agents, increases the importance of side effect management. Sleep disturbances are higher in this group than the general population and no clear mechanism(s) explains this. This systematic review finds a reported effect in 14 of 16 included studies on sleep quality changes for these patients. All reported treatments showed some kind of negative effect on sleep quality, including ADT. Limitations are discussed and recommendations made for progressing the understanding and then for mitigation strategies of these side effects. Abstract Prostate cancer (PCa) treatment involves multiple strategies depending on the disease’s stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced and metastatic stages. Sleep quality has been suggested as being additionally influenced also by local radiotherapy, prostatectomy and androgen-receptor (AR)-targeted agents. We performed a systematic review exploring the landscape of studies published between 1 January 1990 and 31 July 2021, investigating sleep disturbances in PCa patients receiving active treatments, including the influence of hormonal therapy on sleep quality as a factor affecting their quality of life. Out of 45 articles identified, 16 studies were selected, which recruited patients with PCa, undergoing active treatment in either a prospective longitudinal or cross-sectional study. Development of sleep disorders or changes in sleep quality were reported in 14 out of 16 trials included. Only five trials included objective measurements such as actigraphy, mostly at one time point and without a baseline assessment. Limitations to be addressed are the small number of existing trials, lack of randomized trials and heterogeneity of methodologies used. This systematic review outlines the lack of prospective trials investigating sleep disorders, with a rigorous methodology, in homogeneous cohorts of PCa patients. Future trials are needed to clarify the prevalence and impact of this side effect of PCa treatments.
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Affiliation(s)
- Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
| | - Ilenia Napoli
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Radiation Oncology Unit, Department of Biomedical, Dental Science, Morphological and Functional Imaging, University Hospital Messina, 98122 Messina, Italy
| | - Lorenzo Rossi
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
| | - Ricardo Pereira-Mestre
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Institute of Oncology Research (IOR), 6500 Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Department of Neurology, University Hospital Inselspital, 3010 Bern, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Laura Marandino
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Margaret Ottaviano
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Fabio Turco
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Oncology, Division of Medical Oncology, University of Turin San Luigi Gonzaga Hospital, Regione Gonzole, 10043 Orbassano, Italy
| | - Dylan Mangan
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Division of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Ursula Maria Vogl
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Correspondence:
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Robbins R, Hanna R, Ejikeme C, Orstad SL, Porten S, Salter CA, Sanchez-Nolasco T, Vieira D, Loeb S. Systematic review of sleep and sleep disorders among prostate cancer patients and caregivers: A call to action for using validated sleep assessments during prostate cancer care. Sleep Med 2022; 94:38-53. [DOI: 10.1016/j.sleep.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 12/27/2022]
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Chedrawe E, Sathe A, White J, Ory J, Ramasamy R. Testosterone Therapy in Advanced Prostate Cancer. ANDROGENS: CLINICAL RESEARCH AND THERAPEUTICS 2022; 3:180-186. [PMID: 36684061 PMCID: PMC9850445 DOI: 10.1089/andro.2021.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Androgen deprivation therapy is a mainstay of advanced prostate cancer (PCa) but the resulting low testosterone levels leave men susceptible to a multitude of adverse effects. These can include vasomotor symptoms, reduced sexual desire and performance, and mood changes. Testosterone therapy (TTh) in advanced PCa has historically been contraindicated since Huggins and Hodges reported that testosterone activates PCa. Although TTh has been demonstrated to be safe in patients who have undergone treatment for localized PCa, there is extremely limited evidence on its safety in advanced PCa. Despite the lack of evidence, some men with advanced PCa still inquire about TTh, and recent publications have described its use. In this article, we review the potential implications of TTh in men with advanced PCa, defined here as biochemical recurrence after localized therapy or metastatic PCa that is either hormone sensitive or castration resistant.
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Affiliation(s)
- Emily Chedrawe
- Department of Urology, Dalhousie University, Halifax, Canada,Address correspondence to: Emily Chedrawe, MD, Department of Urology, Dalhousie University, 1276 South Park St. Room 293, 5 Victoria, Halifax NS B3H2Y9, Canada,
| | - Aditya Sathe
- Health Science Center College of Medicine, University of Tennessee, Knoxville, Tennessee, USA
| | - Josh White
- Department of Urology, Dalhousie University, Halifax, Canada
| | - Jesse Ory
- Department of Urology, Dalhousie University, Halifax, Canada
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Dickinson K, Lim A, Kupzyk KA. Demographic, Symptom, and Lifestyle Factors Associated With Cancer-Related Fatigue in Men With Prostate Cancer. Oncol Nurs Forum 2021; 48:423-430. [PMID: 34142995 DOI: 10.1188/21.onf.423-430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify potential demographic, symptom, and lifestyle factors associated with cancer-related fatigue (CRF) in men with prostate cancer. SAMPLE & SETTING Data were retrieved from men with prostate cancer across the disease trajectory who were enrolled in the Genitourinary Cancer Collaborative Registry-Prostate Cancer. METHODS & VARIABLES Self-reported data on demographic characteristics, lifestyle habits (smoking history, alcohol consumption, physical activity/exercise, dietary habits, and vitamins/supplements), and symptom experiences (measured using the Brief Fatigue Inventory, European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Prostate Cancer and -Bone Metastasis, and Pittsburgh Sleep Quality Index) were included in the registry. RESULTS Demographic (younger age) and symptom (sleep quality, urinary, bowel, hormone-related, and sexual activity) correlates of CRF were identified. Higher levels of moderate to vigorous exercise and activities were associated with lower CRF in the sample as a whole. However, there was no association between CRF and physical activity in men with bone metastasis. IMPLICATIONS FOR NURSING CRF is a common and burdensome symptom among individuals with cancer and survivors. Identification of demographic, symptom, and lifestyle factors associated with CRF can enhance understanding of this symptom and contribute to early risk assessment and intervention.
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Sharpley CF, Christie DRH, Bitsika V. Depression and prostate cancer: implications for urologists and oncologists. Nat Rev Urol 2020; 17:571-585. [PMID: 32733038 DOI: 10.1038/s41585-020-0354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Many patients with prostate cancer experience severe levels of depression, which can negatively affect their treatment and disease course. Some prostate cancer treatments can increase the severity of a patient's depression, for example, by increasing anhedonia and erectile dysfunction. Depression is often thought of as a unitary phenomenon, but multiple subtypes can be distinguished. This variety of manifestations challenges the successful application of universal antidepressant treatment options and argues for a multi-symptom assessment process that considers a patient's disease burden and their particular form of depression. Inclusion of screening and detailed diagnosis of depression can be argued to be part of good practice, and clinicians are urged to consider when and how this might be accomplished within their urological practice.
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Affiliation(s)
- Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, Australia.
| | - David R H Christie
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, Australia.,Genesiscare, John Flynn Private Hospital, Tugun, Queensland, Australia
| | - Vicki Bitsika
- Brain-Behaviour Research Group, University of New England, Armidale, New South Wales, Australia
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