Use of Testosterone Level as a Biomarker for Quality of Life in Patients with Prostate Cancer
In the treatment of prostate cancer, in addition to surgical treatment, stereotactic body radiotherapy (SBRT) and hormone therapy are also used. Androgen deprivation therapy (ADT) blocks the action or production of male sex hormones and is indicated for the treatment of intermediate and high-risk prostate cancers, where it reduces the risk of metastasis and prolongs survival. The work of experts from several American institutions monitored testosterone levels during therapy and their connection to the development of quality of life scores.
Impact of Treatment on Quality of Life
SBRT is a safe and well-tolerated modality that can be used even in older patients. It reduces testosterone levels by relatively little (10−30%), so it does not cause increased fatigue or sexual dysfunction. On the other hand, the administration of gonadotropin-releasing hormone (GnRH) agonists within ADT results in a decrease in testosterone production and, consequently, in the development of hypogonadism symptoms (fatigue, depression, hot flashes, decreased libido, impotence, gynecomastia, and weight gain).
The return of testosterone production to original levels usually occurs within 6 months after the end of hormone therapy, but this period can be highly variable. A recently published study therefore focused on the development of the hormonal profile and its related quality of life in patients during ADT followed by SBRT.
Study Methodology and Evaluated Patient Population
Patients with localized prostate cancer who underwent combined treatment with neoadjuvant ADT (3–6 months of leuprorelin) and SBRT (35–36.25 Gy in 5 fractions) from January 2009 to May 2018 were included in the retrospective evaluation of prospectively collected data. A total of 122 men aged 55−89 years (median 72 years) were included, of which 52% were white and 27% were obese (BMI > 30). The median follow-up period was 12 months.
Testosterone levels were measured before the start of radiation, every 3 months for 1 year, and then every 6 months after the end of treatment. The return of testosterone levels to original values was defined as achieving a serum concentration > 7.97 nmol/l. Sexual dysfunction and other symptoms of hypogonadism were assessed using the EPIC-26 (Expanded Prostate Index Composite-26) questionnaire before starting ADT, on the first day of SBRT, and at each subsequent check-up. Scores from individual subdomains of the questionnaire were converted to a scale of 0−100 (the lower the value reached, the greater the difficulties experienced by the patient).
Results
The median scores obtained from the EPIC-26 questionnaire before hormone therapy were 94 for hormonal domains and 41 for sexual function domains. 77% of patients underwent 3-month ADT, while the treatment of others lasted longer, but not more than six months. The median testosterone level before the start of SBRT was 0.52 nmol/l (range 0.10−3.09 mmol/l). The quality of life assessed using the EPIC-26 questionnaire in connection with treatment significantly decreased.
At the evaluation 12 months after the end of radiotherapy, 71% of patients reached eugonadal status on average 4 months after the end of SBRT. Approximately original quality of life scores were also achieved at 12 months after the end of radiotherapy.
Discussion and Conclusion
The reduction of testosterone level associated with hormone therapy for prostate cancer leads to a decrease in patients' quality of life. After the end of therapy, testosterone concentration returned to original levels in most men (71% within 1 year, 76% within 18 months). Factors contributing to the extension of this period may include higher age, higher BMI, or lower baseline testosterone levels. In 23% of patients, there was no return to original levels, but most of them probably already had hypogonadism before starting treatment. Improvement in quality of life assessed based on hormonal and sexual functions closely followed the increase in male sex hormone concentration.
The ability to engage in sexual activity is an important part of life; therefore, it is appropriate to discuss this issue with patients and inform them about the possible development of the situation. Simply being aware of the reversibility of sexual dysfunction can have a significant positive psychological effect. The results of the cited study suggest that monitoring testosterone levels can be used with relatively high accuracy to monitor quality of life during prostate cancer therapy.
(kali)
Source: Shah S., Pepin A., Forsthoefel M. et al. Testosterone as a biomarker for quality of life (QOL) following androgen deprivation therapy (ADT) and stereotactic body radiotherapy (SBRT). Cureus 2023 Aug 31; 15 (8): e44440, doi: 10.7759/cureus.44440.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.
