Decision Regret and Bother With the Addition of Androgen Deprivation Therapy to Definitive Radiation Treatment for Localized Prostate Cancer

Victoria Booth; Thomas Eade; George Hruby; Hester Lieng; Chris Brown; Linxin Guo; Haryana Dhillon; Andrew Kneebone

doi:10.1016/j.prro.2023.04.009

Decision Regret and Bother With the Addition of Androgen Deprivation Therapy to Definitive Radiation Treatment for Localized Prostate Cancer

Pract Radiat Oncol. 2023 Sep-Oct;13(5):e400-e408. doi: 10.1016/j.prro.2023.04.009. Epub 2023 May 10.

Authors

Victoria Booth¹, Thomas Eade², George Hruby³, Hester Lieng⁴, Chris Brown⁵, Linxin Guo⁶, Haryana Dhillon⁷, Andrew Kneebone²

Affiliations

¹ Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia. Electronic address: victoria.booth@health.nsw.gov.au.
² Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia; Central Coast Cancer Centre, Gosford, New South Wales, Australia.
³ Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.
⁴ Central Coast Cancer Centre, Gosford, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
⁵ Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia; National Health and Medical Research Council, Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.
⁷ School of Psychology, Faculty of Science, Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 37169149
DOI: 10.1016/j.prro.2023.04.009

Abstract

Purpose: Androgen deprivation therapy (ADT) combined with radiation treatment (RT) is recommended by the National Comprehensive Cancer Network guidelines for unfavorable intermediate and high-risk localized prostate cancer. Although there is a variable survival benefit conferred by ADT, there are potential side effects to consider for patient decision-making. We aimed to assess the side effects and bother of adding ADT to RT, the degree of regret, and what overall survival (OS) benefit men would want to justify adding or extending the duration of ADT, after their experience with this treatment.

Methods and materials: Men receiving ADT with definitive RT completed a questionnaire asking about the side effects and degree of bother from ADT using a 4-point scale. They were also asked about regret, and what survival benefit would warrant ADT.

Results: In the study, 846 patients received definitive RT, of whom 356 received ADT and were asked about their experience with ADT. Of these, 234 responded (66%). In 54%, ADT caused some bother, most commonly hot flushes (32%), fatigue (29%), and sexual problems (29%). Five percent regretted receiving ADT "quite a lot" or "very much." Approximately one-third of men deemed a 1% OS benefit from ADT worthwhile, whereas one-third (34%) would want a >10% OS benefit enough to justify choosing ADT again. In addition, 49% of patients who received short-term ADT would accept longer duration ADT for a 6% OS benefit.

Conclusions: Significant regret for ADT was low (5%). There was a clear dichotomy between those who deemed any OS benefit from ADT worthwhile versus those who needed a significant survival benefit to justify the side effects. Given that some men may change their opinion on the relative value of ADT after experiencing its effects, this study emphasizes the importance of revisiting patients after 6 months to given patients an opportunity to renegotiate their treatment.

MeSH terms

Androgen Antagonists / therapeutic use
Androgens / therapeutic use
Emotions
Humans
Male
Prostatic Neoplasms* / drug therapy
Prostatic Neoplasms* / radiotherapy

Substances

Androgen Antagonists
Androgens