If you are on ADT or know many men who have been on ADT, you know that there is great variation in how easy it is to tolerate ADT. Some men report few side effects and little bother. Others report being overwhelmed by the side effects and look forward to a time when they might have their testosterone back in the normal range for males.
But what accounts for this diversity in distress from ADT? A dozen researchers, mostly based in the USA, teamed up to find out.
The researchers collected a wealth of psychological data on close to 200 men on ADT at baseline, and again at 6- and 12-month follow-ups.
Three distinct patient profiles emerged from the statistical analyses. Men with “high symptom burden” were younger and exhibited higher “levels of depression, stress, cancer-specific distress, and anxiety” at the start of the study. These men often had more advanced symptomatic disease. They also reported worse hormonal symptoms, such as hot flashes, as well as urinary dysfunction, a high degree of sexual bother, and more physical pain compared to the other two groups.
The second group was labeled as a “high sexual bother” group because their distress was focused foremost on sexual dysfunction. Lastly, about half the men were in a "low symptom burden" category and reported fewer symptoms related to hormonal and urinary symptoms, sexual function and pain.
Men with high symptom burden demonstrated significant reductions in anxiety, depression, and cancer-specific distress as well as increased emotional well-being over time.
The authors suggested that men who had greater social support and self-efficacy had better symptom management.
As proposed by the authors, these patient profiles might be clinically useful for the preemptive identification of the subset of men who are most likely to need psychosocial support to manage ADT side effects.
It is already known that younger men are more likely to be bothered by hot flashes. If they also have urinary problems, such as symptoms related to previous cancer treatments, and have symptomatic metastatic disease, ADT side effects are likely to be particularly burdensome.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/35107655/
Reference:
Noriega Esquives B, Lee TK, Moreno PI, Fox RS, Yanez B, Miller GE, Estabrook R, Begale MJ, Flury SC, Perry K, Kundu SD, Penedo FJ. Symptom burden profiles in men with advanced prostate cancer undergoing androgen deprivation therapy. J Behav Med. 2022 Feb 2. doi: 10.1007/s10865-022-00288-4. Epub ahead of print. PMID: 35107655.