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Coelingh Bennink HJT, Prowse A, Egberts JFM, Debruyne FMJ, Huhtaniemi IT, Tombal B. The Loss of Estradiol by Androgen Deprivation in Prostate Cancer Patients Shows the Importance of Estrogens in Males. J Endocr Soc 2024; 8:bvae107. [PMID: 38883397 PMCID: PMC11177789 DOI: 10.1210/jendso/bvae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Indexed: 06/18/2024] Open
Abstract
The role of estradiol (E2; an estrogen) in men needs to be more appreciated. In this review, we address the clinical situations that allow the study of the clinical consequences of E2 deficiency in men and discuss the effects of restoration of levels of this reproductive steroid hormone. In men with advanced prostate cancer (PCa) undergoing androgen deprivation therapy (ADT), E2 is suppressed along with testosterone, leading to side effects affecting the quality of life. These include hot flashes, arthralgia, fatigue, mood changes, cognition problems, weight gain, bone loss, and increased risk of cardiovascular disease. Transdermal E2 alone for ADT has shown equivalent testosterone suppression compared to gonadotropin-releasing hormone (GnRH) agonists while also preventing estrogen-deficiency side effects, including hot flashes and bone loss. Co-treatment of ADT with fetal estrogen estetrol (E4) has shown significant improvements of estrogen-deficiency symptoms. These observations emphasize the need to raise awareness of the importance of estrogens in men among clinicians and the lay public.
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Affiliation(s)
| | - Amanda Prowse
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | - Jan F M Egberts
- Terminal 4 Communications, 1217 SK Hilversum, The Netherlands
| | | | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental Biology, Imperial College London, London SW7 2AZ, UK
| | - Bertrand Tombal
- Division of Urology, University Clinic Saint-Luc, 1200 Brussels, Belgium
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Rencsok EM, Slopen N, McManus HD, Autio KA, Morgans AK, McSwain L, Barata P, Cheng HH, Dreicer R, Gerke T, Green R, Heath EI, Howard LE, McKay RR, Nowak J, Pileggi S, Pomerantz MM, Rathkopf DE, Tagawa ST, Whang YE, Ragin C, Odedina FT, Kantoff PW, Vinson J, Villanti P, Haneuse S, Mucci LA, George DJ. Pain and Its Association with Survival for Black and White Individuals with Advanced Prostate Cancer in the United States. CANCER RESEARCH COMMUNICATIONS 2024; 4:55-64. [PMID: 38108490 PMCID: PMC10773321 DOI: 10.1158/2767-9764.crc-23-0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
Bone pain is a well-known quality-of-life detriment for individuals with prostate cancer and is associated with survival. This study expands previous work into racial differences in multiple patient-reported dimensions of pain and the association between baseline and longitudinal pain and mortality. This is a prospective cohort study of individuals with newly diagnosed advanced prostate cancer enrolled in the International Registry for Men with Advanced Prostate Cancer (IRONMAN) from 2017 to 2023 at U.S. sites. Differences in four pain scores at study enrollment by race were investigated. Cox proportional hazards models and joint longitudinal survival models were fit for each of the scale scores to estimate HRs and 95% confidence intervals (CI) for the association with all-cause mortality. The cohort included 879 individuals (20% self-identifying as Black) enrolled at 38 U.S. sites. Black participants had worse pain at baseline compared with White participants, most notably a higher average pain rating (mean 3.1 vs. 2.2 on a 10-point scale). For each pain scale, higher pain was associated with higher mortality after adjusting for measures of disease burden, particularly for severe bone pain compared with no pain (HR, 2.47; 95% CI: 1.44-4.22). The association between pain and all-cause mortality was stronger for participants with castration-resistant prostate cancer compared with those with metastatic hormone-sensitive prostate cancer and was similar among Black and White participants. Overall, Black participants reported worse pain than White participants, and more severe pain was associated with higher mortality independent of clinical covariates for all pain scales. SIGNIFICANCE Black participants with advanced prostate cancer reported worse pain than White participants, and more pain was associated with worse survival. More holistic clinical assessments of pain in this population are needed to determine the factors upon which to intervene to improve quality of life and survivorship, particularly for Black individuals.
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Affiliation(s)
- Emily M. Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Karen A. Autio
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Pedro Barata
- Section of Hematology and Oncology, Tulane University School of Medicine, New Orleans, Louisiana
- University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Heather H. Cheng
- Division of Medical Oncology, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Center, Seattle, Washington
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Travis Gerke
- Prostate Cancer Clinical Trials Consortium (PCCTC), New York, New York
| | - Rebecca Green
- Prostate Cancer Clinical Trials Consortium (PCCTC), New York, New York
| | | | | | - Rana R. McKay
- Department of Oncology, University of California San Diego Moores Cancer Center, La Jolla, California
| | - Joel Nowak
- Patient author, Durham, North Carolina
- Cancer ABCs, Brooklyn, New York
| | - Shannon Pileggi
- Prostate Cancer Clinical Trials Consortium (PCCTC), New York, New York
| | | | | | - Scott T. Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, New York
| | - Young E. Whang
- Department of Medicine, Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Camille Ragin
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
- African-Caribbean Cancer Consortium, Philadelphia, Pennsylvania
| | - Folakemi T. Odedina
- Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, Florida
| | - Philip W. Kantoff
- Memorial Sloan Kettering Cancer Center, New York, New York
- Convergent Therapeutics, Cambridge, Massachusetts
| | - Jake Vinson
- Prostate Cancer Clinical Trials Consortium (PCCTC), New York, New York
| | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Rencsok EM, Slopen N, Autio K, Morgans A, McSwain L, Barata P, Cheng HH, Dreicer R, Heath E, McKay RR, Pomerantz M, Rathkopf D, Tagawa S, Whang YE, Ragin C, Odedina FT, George DJ, Kantoff PW, Vinson J, Villanti P, Haneuse S, Mucci LA. Quality of life in the year after new diagnosis with advanced prostate cancer for Black and White individuals living in the US. Qual Life Res 2023; 32:3209-3221. [PMID: 37410340 PMCID: PMC10711502 DOI: 10.1007/s11136-023-03468-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To assess differences in baseline and longitudinal quality of life among Black and White individuals in the US with advanced prostate cancer. METHODS Secondary analysis of data from the International Registry for Men with Advanced Prostate Cancer (IRONMAN) including US participants newly diagnosed with advanced prostate cancer and identifying their race as Black or White from 2017 to 2023. Participants completed the EORTC QLQ-C30 Quality of Life (QoL) Survey at study enrollment and every 3 months thereafter for up to 1 year of follow-up reporting 15 scale scores ranging from 0 to 100 (higher functioning and lower symptom scores represent better quality of life). Linear mixed effects models with race and month of questionnaire completion were fit for each scale, and model coefficients were used to assess differences in baseline and longitudinal QoL by race. RESULTS Eight hundred and seventy-nine participants were included (20% identifying as Black) at 38 US sites. Compared to White participants at baseline, Black participants had worse constipation (mean 6.3 percentage points higher; 95% CI 2.9-9.8), financial insecurity (5.7 (1.4-10.0)), and pain (5.1 (0.9-9.3)). QoL decreased over time similarly by race; most notably, role functioning decreased by 0.7 percentage points (95% CI -0.8, -0.5) per month. CONCLUSION There are notable differences in quality of life at new diagnosis of advanced prostate cancer for Black and White individuals, and quality of life declines similarly in the first year for both groups. Interventions that address specific aspects of quality of life in these patients could meaningfully improve the overall survivorship experience.
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Affiliation(s)
- Emily M Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA.
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karen Autio
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Pedro Barata
- Section of Hematology and Oncology, Tulane University School of Medicine, New Orleans, LA, USA
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Heather H Cheng
- Division of Medical Oncology, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA, USA
| | | | - Rana R McKay
- Department of Oncology, University of California San Diego Moores Cancer Center, La Jolla, CA, USA
| | | | - Dana Rathkopf
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Scott Tagawa
- Division of Hematology and Medical Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Young E Whang
- Department of Medicine, Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Camille Ragin
- Fox Chase Cancer Center, Philadelphia, PA, USA
- African-Caribbean Cancer Consortium, Philadelphia, PA, USA
| | - Folakemi T Odedina
- Mayo Clinic Comprehensive Cancer Center, Jacksonville, FL, USA
- Prostate Cancer Transatlantic Consortium (CaPTC), Jacksonville, FL, USA
| | | | - Philip W Kantoff
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Convergent Therapeutics, Cambridge, MA, USA
| | - Jacob Vinson
- Prostate Cancer Clinical Trials Consortium (PCCTC), New York, NY, USA
| | | | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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