ASCO GU 2023: Patient Perspective on Fatigue and Its Management for Advanced Prostate Cancer Treated with Androgen Receptor Inhibitors (ARIs)

( Dr. Stephen Freedland and colleagues presented data on the patient perspective on fatigue related to androgen receptor inhibitor (ARI) use in men with advanced prostate cancer (PC). The authors note that fatigue is a very common, but multifaceted, symptom related to both treatment and disease. It is often experienced by patients with advanced PC – but they note, although fatigue of variable severity has been reported across clinical trials in men with metastatic hormone-sensitive PC (also referred to as metastatic castration-sensitive PC [mCSPC]) and non-metastatic castration-resistant PC (nmCRPC) treated with ARIs, there is limited real-world insight from the pt’s perspective or guidance on the management of this symptom.

To address this, the authors proceeded with a cross-sectional non-interventional qualitative research study. Men receiving ARIs were interviewed about their fatigue experience and management strategies. All pts were ≥18 years, diagnosed with mCSPC or nmCRPC, currently on ARI treatment (enzalutamide, apalutamide or darolutamide) that began ≤ 24 months (mo) prior to interview, and experienced fatigue. Descriptive data extracted were organized into general concepts and presented as number and frequency of reports.

The study profile is below:

androgen receptor inhibitor.jpg

Jumping to results, they enrolled 11 patients for the interview – 7 mHSPC and 4 nmCRPC. Baseline characteristics are seen below:


Patients described their fatigue experience as a physical, emotional, or mental feeling that impacted activities of daily living – and they used the term fatigue more commonly than tiredness or exhaustion. They attributed their fatigue to more than one cause including, but not limited to: a side effect of ARI treatment, emotional burden of disease, or physical exertion.


Most men did not feel adequately prepared and indicated they would have liked to receive additional education or support to manage treatment-related fatigue. As a result, most men followed self-initiated management strategies (82%) such as healthy diet, rigorous exercise and increased rest. Some received guidance from a physician (27%) or family and friends (9%). Management strategies were reported to be effective for some men (see below):


Presented by: Stephen J. Freedland, MD, Cedars-Sinai Medical Center, Durham VA Medical Center

Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Associate Professor of Urology, University of California, Davis @tchandra_uromd on Twitter during the 2023 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, Thurs, Feb 16 – Sat, Feb 18, 2023.