Quality-of-life outcomes after primary androgen deprivation therapy: Results from the prostate cancer outcomes study

Purpose : To compare health-related quality-of-life outcomes after primary androgen deprivation (AD) therapy with orchiectomy versus luteinizing hormo ne-releasing hormone (LHRH) agonists for patients with prostate cancer. Patients and Methods: Men (n = 431) newly diagnosed with all stages of pros tate cancer from six geographic regions who participated in the Prostate Ca ncer Outcomes Study and who received primary AD therapy but no other treatm ents within 12 months of initial diagnosis were included in a study of heal th outcomes. Comparisons were statistically adjusted for patient sociodemog raphic and clinical characteristics, timing of therapy, and use of combined androgen blockade. Results: More than half of the patients receiving primary AD therapy had be en initially diagnosed with clinically localized prostate cancer. Among the se patients, almost two thirds were at high risk of progression on the basi s of prognostic factors. Sexual function outcomes were similar by treatment group both before and after implementation of AD therapy. LHRH patients re ported more breast swelling than did orchiectomy patients (24.9% v 9.7%, P < .01). LHRH patients reported more physical discomfort and worry because o f cancer or its treatment than did orchiectomy patients. LHRH patients asse ssed their overall health as fair or poor more frequently than did orchiect omy patients (35.4% v 28.1%, P = .01) and also were less likely to consider themselves free of prostate cancer after treatment. Conclusion: Most endocrine-related health outcomes are similar after surgic al versus medical primary hormonal therapy. Stage at diagnosis had little e ffect on outcomes. These results provide representative information compari ng surgical and medical AD therapy that may be used by physicians and patie nts to inform treatment decisions. (C) 2001 by American Society of Clinical Oncology.