Understanding prostate cancer hormone therapy “syndrome”

Men with prostate cancer may be put on hormone therapy, to block testosterone production in an effort to halt or slow tumor growth. While some health effects of so-called “androgen deprivation therapy” (ADT) for prostate cancer are clearcut—for example sexual dysfunction—there is this whole set of less specific, more vague symptoms, like changes in mood, memory, feeling unwell, being tired. A new study suggests that these symptoms are likely due to the fact that the patients are older, sicker and have more advanced disease.

“Androgen deprivation is probably not playing a big role in causing these symptoms,” said Dr. Vahakn B. Shahinian of the University of Texas Medical Branch in Galveston.

Based on the findings, he added, the therapy should not be avoided in patients for whom it is indicated based on concerns that they will develop symptoms collectively known as “androgen deprivation syndrome.”

Shahinian and colleagues assessed the rate of depression, cognitive impairment or constitutional symptoms (weight loss, fever, fatigue, malaise) in 50,476 men with prostate cancer and 50,476 men without the disease. They report their findings in the Archives of Internal Medicine.

Among men who received ADT, 31 percent had at least one diagnosis of depression, cognitive problems or constitutional symptoms, compared to 24 percent of prostate cancer patients who weren’t given the therapy, and 23 percent of the non-cancer cohort.

However, after adjustment for age, other illnesses, stage of disease and other relevant variables, the differences between the prostate cancer groups either disappeared or were greatly diminished.

After adjustment, men on the therapy were 8 percent more likely to have a depression diagnosis, 1 percent less likely to have cognitive impairment, and 17 percent more likely to have constitutional symptoms.

Therefore, ADT is probably not a major player in causing these symptoms, the authors conclude.

SOURCE: Archives of Internal Medicine February 27, 2006.

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