AUA 2020: Quality of Life of Prostate Cancer Patients with Testosterone Deficiency Symptoms Before Initiation of Gonadotropin-Releasing Hormone Agonist Therapy, Subgroup Analysis of EQUINOXE Study

(UroToday.com) Prostate cancer and testosterone deficiency symptoms increase with age. Therefore, patients may suffer from both conditions, and their quality of life could be significantly reduced.

The EQUINOXE (NCT02630641) is an observational study in prostate cancer patients initiating GNRH agonist therapy and included 492 patients and their partners. The objective of this currently complimentary presented study was to describe the baseline parameters of patients with testosterone deficiency symptoms at baseline.

This was a prospective, multicenter, longitudinal, non-interventional study conducted in France. Patients with histologically confirmed prostate cancer, who were eligible to start GNRH agonist therapy, and their partners were included in this study. Baseline and six-month follow-up data were analyzed, including data from their partners, using various questionnaires. The objective was to evaluate the evolution of the quality of life after six months of agonist hormonal therapy.

Several questionnaires were used, as demonstrated in Table 1.

Table 1 – questionnaires used:

QuestionairesUsed_AUA2020.png

The results demonstrated that there was an improvement in at least 1 of the 4 dimensions of the patient’s WHOQOL-BREF questionnaire (physical, psychological, social, and environmental) in 66.8% of patients. Moreover, there was an improvement in the partner’s quality of life during the 6-month period in 15.2% of partners.

Multivariable analysis revealed that a QLQ-PR25 treatment-related symptoms score >=25/100 at baseline, which is a quality of life questionnaire specific to prostate cancer, was a significant factor of quality of life improvement after a 6-month follow-up (OR 3, 95% CI 1.46-6.17), for patient quality of life, and (OR 5.99, 95% CI 2,40-14,93) for the partner’s quality of life.

Not all patients received hormonal therapy at baseline, and those patients who did not receive treatment but who had treatment-related symptoms at baseline were considered to have testosterone deficiency symptoms.

All dimensions of the WHOQOL-BREF at baseline were rated significantly worse in patients with testosterone deficiency symptoms at baseline than in those without testosterone deficiency symptoms at baseline (Figure 1).

Figure 1- Sub-scores of quality of life (WHOQOL-BREF) questionnaire:

Sub-ScoresQualityofLife_Figure1_AUA2020.png

The total score of illness (B-IPQ) and cohesion in the couple (DAS score) were both significantly worse at baseline in patients with testosterone deficiency symptoms (Table 2).

Table 2 – Total score of illness (B-IPQ) and DAS score at baseline:

TotalScoreIllness_AUA2020.png

In conclusion, 26% of the EQUINOXE patients had testosterone deficiency symptoms at baseline. This subgroup analysis demonstrated that patients with testosterone deficiency symptoms at baseline experienced a worse cohesion of the couple at baseline and a lower quality of life than patients who did not have testosterone deficiency symptoms.

Patients with testosterone deficiency symptoms at baseline benefited relatively more from androgen deprivation therapy (GNRH agonists) with regards to their quality of life, as was previously shown in the final analysis of the EQUINOXE study (6-month follow-up).

Lastly, these data suggest a better way to evaluate patients when starting androgen deprivation therapy and enable us to improve personalized supportive care.

Presented by: Stephane Droupy, Chu de Nimes, Université de Montpellier, Nimes, France

Written by: Hanan Goldberg, MD, MSc., Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA, Twitter: @GoldbergHanan, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27- 28, 2020.

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