1. Improving Quality of Life (QoL) in Hormonal Therapy (ADT)
Derek J. Rosario
Senior Lecturer and Hon. Consultant Urological Surgeon
Academic Urology Unit and Department of Urology
Royal Hallamshire Hospital

2. Scope of this talk Historical view of ADT
Mitigation of adverse events / impact on QoL
Limiting exposure
Pharmacological interventions
Exercise interventions
Dietary supplements/ complementary therapies

3. Scope of this talk Mitigation of adverse events Limiting exposure
Pharmacological interventions
Exercise interventions
Dietary supplements/ complementary therapies

4. Charles Édouard Brown-Séquard (1817– 1894)
Testosterone
‘Elixir’ of vitality
Charles Édouard Brown-Séquard (1817– 1894)

7. Non-beneficial effects of Androgen withdrawal (ADT)

8. Impact of ADT on Generic QoL
SF36
J Urol 191:964, 2014

9. Results
Limitations
Selection bias
Primary ADT older at outset

10. Duration of Adjuvant ADT
630 men randomised to 18 months vs. 36 months adjuvant ADT
EORTC QLQ 30 and PR25
72% adherence to completion of questionnaire
21 scales (15 on EORTC QLQ 30 and 9 on PR25)
Nabid A et al. Long-term QoL in high-risk prostate cancer: Results of a phase III randomized trial. J Clin Oncol 32, 2014 (suppl 4; abstr 5).

11. Results (Nabid et al 2014)
Statistically significant improvement in 6/21 scales
Effect size (clinical relevance) greatest for sexual interest, functioning and hot flashes

12. Pharmacological interventions
Nguyen PL doi: /j.eururo [Epub ahead of print]

13. Problem Intervention Evidence QoL Impact
Bone Health
Gynaecomastia
Hot flashes / flushes

14. Problem Intervention Evidence QoL Impact
Bone Health
Pamidronate
Zoledronate
Denosumab
Toremifene
Prevents decrease in BMD
Increase in BMD
Decrease in fracture risk
Decreased fracture but increased DVT
Gynaecomastia
Hot flashes / flushes

15. Both reduce gynaecomastia significantly
Problem
Intervention
Evidence
QoL
Impact
Bone Health
Gynaecomastia
Breast irradiation
Tamoxifen
Both reduce gynaecomastia significantly
Hot flashes / flushes

16. All reduce hot flashes but MP/ cyproterone more effective
Problem
Intervention
Evidence
QoL
Impact
Bone Health
Gynaecomastia
Hot flashes / flushes
Venlafaxine
medroxyprogesterone
cyproterone
All reduce hot flashes but MP/ cyproterone more effective

17. Problem Intervention Evidence QoL Impact
Bone Health
Pamidronate
Zoledronate
Denosumab
Toremifene
Prevents decrease in BMD
Increase in BMD
Decrease in fracture risk
Decreased fracture but increased DVT ?
Gynaecomastia
Breast irradiation
Tamoxifen
Both reduce gynaecomastia significantly
Hot flashes / flushes
Venlafaxine
medroxyprogesterone
cyproterone
All reduce hot flashes but MP/ cyproterone more effective

18. Exercise interventions

19. Objectives Rigorous systematic review and metaanalysis
Effects of exercise interventions on Cancer-specific QoL
Effects of exercise interventions on disease-progression
Effects on cardiovascular health
Adverse effects of exercise interventions

20. QoL and Fatigue

21. Disease-progression (PSA)

22. Improving QoL in ADT Adverse events common Reduce exposure to ADT
Discuss with the patient before initiating treatment
Reduce exposure to ADT
Duration of adjuvant ADT
Exercise interventions
? Supervised
? Adherence

23. Focus of Studies
Better studies examining and reporting QoL Avoid narrow focus on Survival alone