ASTRO: Shorter Course of Androgen-Deprivation Therapy Yields Improved Quality of Life for High-Risk Prostate Cancer Patients
Patients with high-risk prostate cancer who received radiation therapy and an 18-month course of androgen-deprivation therapy recovered a normal testosterone level in a shorter amount of time compared to those who received a 36-month course of androgen-deprivation therapy. The shorter course of therapy resulted in a better quality of life without detriment to long-term outcomes, according to research presented at the American Society for Radiation Oncology’s (ASTRO’s) 56th Annual Meeting (Abstract 24).
Study Details
Researchers analyzed data from 561 patients with high-risk prostate cancer from a multicenter, randomized phase III trial in Canada. The patients received radiation therapy and long-term androgen-deprivation therapy.
Patients were randomly assigned into two groups: one group of 289 patients who received 18 months of androgen-deprivation therapy and radiation therapy, and a second group of 272 patients who received 36 months of androgen-deprivation therapy and radiation therapy. In both groups, radiation therapy started 4 months after the beginning of androgen-deprivation therapy.
Patients’ serum testosterone levels were measured at baseline and then at each follow-up visit to assess testosterone levels and recovery time. The study defined normal testosterone level as the normal ranges given by each hospital lab participating in the trial. The time to testosterone recovery between the two groups was compared via Kaplan Meier and log rank tests. All items and scales scores were analyzed with general linear model and repeated measures. Researchers evaluated changes between patients who did recover normal testosterone levels over time vs those who did not.
Shorter Duration of Therapy, Better Quality of Life
With a median follow-up time of 84 months, 55.7% (161) patients in the 18-month androgen-deprivation therapy group recovered normal testosterone levels. In comparison, 44.9% (122) patients of the 36-month androgen-deprivation therapy group recovered normal testosterone levels. Additionally, median time to testosterone recovery was shorter (47.2 months; range, 40.1–54.3 months), in the 18-month group, compared to the 36-month group (73.2 months; range, 58.3–88.2 months.
Patients’ quality-of-life measurements were assessed using the 30-item EORTC30 questionnaire and the 25-item EORTC PR25 questionnaire. The 55 items were regrouped into 21 scales; all items and scales scores were linearly transformed to a 0- to 100-point scale. Patient-reported questionnaires were completed before treatment; every 6 months during androgen-deprivation therapy; 4 months post androgen-deprivation therapy; and then once a year for 5 years after treatment. For patients who developed biochemical failure (elevated prostate specific antigen [PSA] levels), quality of life evaluations ceased upon beginning a new course of androgen-deprivation therapy.
When comparing quality of life between patients who recovered normal testosterone with those who did not, patients with testosterone recovery had a better quality of life: 26 of 55 items and 12 of 21 scales were statistically significant. Similarly, 5 of 26 items and 1 of 21 scales that reached statistical significance were also clinically relevant.
“The results of the analysis are not surprising considering the side effects of androgen-deprivation therapy, and that testosterone recovery has significant impact on patients’ improved quality of life,” said lead author Abdenour Nabid, MD, a radiation oncologist at Centre Hospitalier Universitaire de Sherbrooke and an Associate Professor at the University of Sherbrooke in Québec, Canada. “In high-risk prostate cancer, the current guideline for androgen-deprivation therapy duration is between 2 and 3 years. Because of improvement in testosterone recovery and quality of life, a good first step could be to choose androgen-deprivation therapy for 2 years until we obtain the final results of the ongoing phase III PCS IV trial, which compares 18 months of androgen-deprivation therapy to 36 months of androgen-deprivation therapy.”
The study was funded by AstraZeneca. Dr. Nabid reported a research grant from AstraZeneca, honoraria from Sanofi, and travel expenses paid by Sanofi.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
