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Quality-of-Life Outcomes After Primary Androgen Deprivation Therapy: Results From the Prostate Cancer Outcomes Study

From the Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Division of Urology, University of Connecticut Health Center, Farmington, CT; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, CA; New Mexico Tumor Registry, University of New Mexico Health Sciences Center, and Medical Service, Department of Veterans Affairs Medical Center, Albuquerque, NM; Georgia Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, GA; and Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.

Address reprint requests to Arnold L. Potosky, PhD, Applied Research Branch, National Cancer Institute, Executive Plaza North Rm 4005, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344; email: potosky{at}nih.gov

PURPOSE: To compare health-related quality-of-life outcomes after primary androgen deprivation (AD) therapy with orchiectomy versus luteinizing hormone-releasing hormone (LHRH) agonists for patients with prostate cancer.

PATIENTS AND METHODS: Men (n = 431) newly diagnosed with all stages of prostate cancer from six geographic regions who participated in the Prostate Cancer Outcomes Study and who received primary AD therapy but no other treatments within 12 months of initial diagnosis were included in a study of health outcomes. Comparisons were statistically adjusted for patient sociodemographic and clinical characteristics, timing of therapy, and use of combined androgen blockade.

RESULTS: More than half of the patients receiving primary AD therapy had been initially diagnosed with clinically localized prostate cancer. Among these patients, almost two thirds were at high risk of progression on the basis of prognostic factors. Sexual function outcomes were similar by treatment group both before and after implementation of AD therapy. LHRH patients reported more breast swelling than did orchiectomy patients (24.9% v 9.7%, P < .01). LHRH patients reported more physical discomfort and worry because of cancer or its treatment than did orchiectomy patients. LHRH patients assessed their overall health as fair or poor more frequently than did orchiectomy patients (35.4% v 28.1%, P = .01) and also were less likely to consider themselves free of prostate cancer after treatment.

CONCLUSION: Most endocrine-related health outcomes are similar after surgical versus medical primary hormonal therapy. Stage at diagnosis had little effect on outcomes. These results provide representative information comparing surgical and medical AD therapy that may be used by physicians and patients to inform treatment decisions.

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