For Manuscript Submission, Check or Review Login please go to Submission Websites List.
For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.
Quality of Life Issues Relating to Endocrine Treatment OptionsIversen P.
Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Recent interest has focused on the use of hormone therapy in prostate cancer for both the management of patients with non-metastatic disease and as a neoadjuvant or adjuvant to curative therapies. This has resulted in patients with fewer symptoms being treated for longer periods of time. Endocrine treatments for prostate cancer, such as castration, combined androgen blockade and non-steroidal antiandrogen monotherapy, have shown similar results in terms of time to progression and survival. The main difference between these treatments is their impact on patients’ quality of life. Instruments for measuring health-related quality of life should assess both overall and disease-specific quality of life. Data from two large studies of bicalutamide monotherapy show that this non-steroidal antiandrogen is associated with significant health-related quality of life advantages in the treatment of patients with locally advanced (M0) disease compared with castration, suggesting that this treatment may benefit patients with early disease. Bicalutamide was favoured in 8 out of 9 evaluable quality of life dimensions, and this was statistically significant for sexual interest and physical capacity. Endocrine treatments with minimal adverse effects on quality of life will be increasingly favoured for patients with non-metastatic disease who are being treated for longer periods of time.
The patient described by Dr. Iversen was a 60-year-old lawyer who presented with slight prostatism. He was otherwise healthy, capable of physical exercise and sexually active. He had remarried 6 years earlier to a wife 20 years his junior and had two young sons aged 3 and 5 years. On digital rectal examination, the patient had a slightly indurated left lobe. Investigations revealed the following: an elevated PSA of 48 ng/ml, a Gleason score of 6 in 4/6 sextant biopsies, carcinoma in a biopsy from the base of the left seminal vesicles, and a normal bone scan.
Panel members agreed that the patient had a very aggressive tumour and, therefore, radical prostatectomy was not a viable option. Dr. Iversen felt that radiotherapy was worth considering and, with this in mind, he would obtain a lymph node biopsy. If the lymph nodes were clear of tumour, he would have suggested radiotherapy combined with hormonal treatment. However, the patient did not want radiotherapy and opted for hormonal treatment. The patient wished to retain sexual interest and function while receiving treatment. Dr. Iversen started bicalutamide 150 mg monotherapy, having discussed it thoroughly with the patient. Bicalutamide 150 mg monotherapy has been approved in the UK and Norway for the management of patients with locally advanced non-metastatic prostate cancer. Regulatory packages have also been submitted to a number of other countries.
Bicalutamide 150 mg monotherapy has been approved in the UK and Norway for the management of patients with locally advanced non-metastatic prostate cancer. Regulatory packages have also been submitted to a number of other countries.
The patient’s prostatism began to improve. Libido was unchanged, although he did experience some erectile dysfunction, which was treated successfully with 50 mg sildenafil. He experienced mild, painless gynaecomastia after 6 months, despite the radiotherapy, and also complained of being slightly tired during the first 6 months. After 16 months, his PSA was <1 ng/ml and he had maintained a normal professional and private life; his only complaint was a loss of chest hair. Bicalutamide 150 mg was continued.
When asked about the patient’s subsequent therapy, Dr. Iversen said that if the patient progressed, he would step up the treatment probably to either medical or surgical castration.