Over the years we have talked to hundreds of prostate cancer patients, who have previously been on ADT, about how bothered they were by ADT side effects. The responses covered the spectrum. Some patients felt they had no side effects at all. Others swore they would never go back on ADT because they found the side effects so intolerable.
We didn’t ask though whether those who were on ADT short term to improve the effectiveness of radiotherapy used to treat localized disease, had such significant regret that they would decline going back on it, if they experienced “biochemical failure” (i.e., a rising PSA indicative of disease progression).
Concern about ADT regret negatively influencing patients’ willingness to go back on ADT led a group of researchers in Australia to search for factors that influence ADT regret (Booth et al. 2023). The researchers hypothesized that the more bothered a patient was from ADT side effects, the more regret they would have. So, they surveyed 234 patients about the side effects they experienced and how bothersome they were. Next, they asked the patients who had significant regret, what sort of survival benefit they would want to be willing to go on ADT a second time if they experienced disease progression.
The side effects that the patients found most bothersome were the common ones reported from many other studies, e.g., hot flashes, fatigue, and sexual problems. But despite the side effects, the level of regret was over all quite low. Although a third of the men with regret said that they would hope for a >10% survival benefit to be willing to go on ADT again, we don’t know if that would remain true if they were experiencing pain from advancing disease.
In a search for factors that correlate with ADT regret, such as patients’ age, time since treatment, and comorbidities, the one variable that stood out strongly was biochemical failure post-radiotherapy administered with curative intent along with adjuvant ADT. This is hardly surprising. If a patient undergoes any cancer treatment with the hope that it will be curative and it is not, they may view the treatment as a waste of time, with no benefit, just side effects.
What the researchers didn’t consider is how well informed the patients were about ADT side effects beforethey started on ADT. Although Booth et al. (2023) doesn’t cite Wibowo et al. (2020), where we show that educating patients ahead of time about ADT side effects—and ways to manage those side effects—reduce bother from that treatment. Indeed, pre-emptive education increases patients’ self-efficacy in managing ADT side effects.
Whereas education about ADT before starting on the drugs can significantly reduce side effect, neither Booth et al. (2023) nor Wibowo et al. (2000) investigated whether knowing what to expect influences patient willingness to go back on ADT, if they experience biochemical failure after early treatment. Hopefully, Booth et al. or others will follow-up on that.
References:
Booth, V., Eade, T., Hruby, G., Lieng, H., Brown, C., Guo, L., ... & Kneebone, A. (2023). Decision regret and bother with the addition of androgen deprivation therapy to definitive radiation treatment for localised prostate cancer. Practical Radiation Oncology (in press).
Wibowo, E., Wassersug, R. J., Robinson, J. W., Santos-Iglesias, P., Matthew, A., McLeod, D. L., & Walker, L. M. (2020). An Educational Program to Help Patients Manage Androgen Deprivation Therapy Side Effects: Feasibility, Acceptability, and Preliminary Outcomes. American journal of men's health, 14(1), 1557988319898991. https://doi.org/10.1177/1557988319898991