Impact of alternative antiandrogen therapy for Japanese prostate cancer patients in the era of new hormonal therapy

5091 Background: Prostate cancer patients with locally advanced /metastatic disease have a poor prognosis and although hormonal therapy can induce long-term remission, development of hormone-resistant prostate cancer (HRPC) is inevitable. The goal of this study is to evaluate overall survival in HRPC patients with different transition of care in the Veterans Affairs (VA) system. We hypothesized that prostate cancer patients with late referral to medical oncologists were more likely to have decreased overall survival. Methods: This is a retrospective, observational analysis of patients enrolled in the Veterans Health Administration system from October 2003 to March 2011. Patients were followed from initial evaluation and treatment by urology until an endpoint of death or the end of the study period. VA patients with a diagnosis of HRPC were identified; prostate specific antigen (PSA), medical and pharmacy records were collected. HRPC was defined as PSA doubling after treatment with hormonal therapy. Transition of care was defined as two encounters with the medical oncology service and at least one encounter was a medical oncologist. Three cohorts were created: patients transitioned to oncology before HRPC, those transitioned to oncology after HRPC, and patients who were never transitioned to oncology. Primary outcome was overall survival (OS). The Charlson score was utilized for comorbidity assessment. Statistical analysis was conducted using chi square test for categorical variables. Results: Total number of patients evaluated was 8,281; 2,168 in transition before HRPC (tbHRPC) cohort, 2,052 in transition after HRPC (taHRPC), and 4,061 patients that never transitioned (tnHPRC). The mean ages for the respective cohorts were: 69.35, 69.69, and 71.64. The Charlson comorbidity scores were 3.79 (tbHRPC), 3.06 (taHRPC), and 3.14 (tnHRPC); p-values < 0.05. Mortality rates among the cohorts were 57% tbHRPC, 69% taHRPC, and 62% tnHRPC; p-values <0.001. PSA doubling within 10 months were: 57% tbHRPC, 60% taHRPC, and 54% tnHRPC; p-values < 0.05. Conclusions: Overall survival was improved among prostate cancer patients that transitioned to oncology before becoming HRPC.

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The prevalence of vasomotor and psychological symptoms in prostate cancer patients receiving hormonal therapy: Results from a single-institution experience.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.283 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 283-283

Author(s):

Amarnath Challapalli ◽

Waqar Saleem ◽

Ernese Gjafa ◽

Marc Laniado ◽

Bente Stanbridge ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Hormonal Therapy ◽

Sleep Disturbances ◽

Psychological Symptoms ◽

Therapeutic Modality ◽

Severe Toxicity ◽

Breast Cancer Patients ◽

Long Term Effects ◽

Short Term

283 Background: Hormonal therapy is an important therapeutic modality in both early and metastatic prostate cancer. Whilst the long term effects of androgen deprivation (AD) have been extensively studied, little attention has focussed on assessing short-term vasomotor and psychological effects and the resulting impact of quality of life (QoL) in prostate cancer, relying on data mainly extrapolated from breast cancer patients. This prospective study sought to assess these effects and identify any predictive factors. Methods: Data from 200 consecutive prostate cancer patients were collected from January 2010 to August 2013. A self-reported questionnaire was employed to objectively assess a variety of vasomotor and psychological symptoms, graded from 1 no toxicity, 2 mild, 3 moderate to 4 severe toxicity. Other parameters including height, weight, Body Surface Area (BSA), Body Mass Index (BMI), duration and type of hormonal therapy were also recorded. Results: 181 patients were fully evaluable, with a median age of 75 (IQR 70.5-80). 166 received an LHRH analogue,11 maximum androgen blockade, and 4 received anti-androgens only. 33 (18.2%) of patients reported no toxicity, with 76 (42%), 55 (30%) and 17 (9.4%) experiencing mild, moderate and severe (debilitating) symptoms respectively. The commonest debilitating symptoms were vasomotor: drenching sweats (82%), and hot flashes (82%), which usually coexisted, and less commonly psychological: sleep disturbances (18%) and tiredness (12%). Age (median: 77 vs. 74 yrs), weight (median: 79.8 vs. 84.4), and BMI (median: 26.6 vs. 28.3) significantly predicted between those with grade 1/2 and grade 3/4 symptoms, (p=0.0007, 0.02, 0.02). A non-significant trend was observed with increasing duration of hormonal treatment and toxicity (median: 5, 7, 9.5 and 12 months for Grade 1-4, respectively, p=0.07). Conclusions: The short term side-effect profile of hormonal therapy for prostate cancer is generally favourable, though debilitating predominantly vasomotor symptoms can occur in a significant minority of cases. Increasing age, weight, and BMI may be predictive of toxicity.

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