Dacal Kirsten, Sereika Susan M, Greenspan Susan L
School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 2006 Jan;54(1):85-90. doi: 10.1111/j.1532-5415.2005.00567.x.
To examine the effect of androgen deprivation therapy (ADT) on health-related quality of life (HRQOL), self-reported HRQOL was compared in prostate cancer patients receiving short- (< 6 months) or long-term (> or = 6 months) ADT and healthy controls.
Cross-sectional study.
Academic medical center in Pittsburgh, Pennsylvania.
Ninety-six men, including those with prostate cancer receiving short-term, long-term, and no ADT and healthy controls. Men taking medications or having diseases known to affect bone mineral metabolism were excluded.
The 36-item Short Form Medical Outcomes Study Health Survey (an HRQOL assessment) and a comorbidity index were administered to each participant. Characteristics, including body composition (assessed using dual-energy x-ray absorptiometry) and gonadal status (serum total and free testosterone) were measured approximately 3 months or less before the HRQOL assessment.
As expected, men receiving ADT had significantly lower levels of testosterone, free testosterone, and lean body mass, as well as greater body fat and comorbidity index (all P<.01) than men not receiving ADT (i.e., men with prostate cancer and healthy controls). Participants receiving ADT reported significantly poorer QOL in the areas of physical function (P<.001), general health (P<.001), and physical health component summary (P<.001) than men not receiving ADT. There were no significant differences in HRQOL outcomes between participants receiving short- or long-term ADT. Comorbidity and testosterone levels were associated with several QOL scales. After controlling for the significant joint predictors of comorbidity and total testosterone using hierarchical regression analysis, ADT was no longer a significant predictor, and only comorbidity and total testosterone contributed to the explanation of the variance of the physical health component summary. Comorbidity alone contributed to the explanation of the variance in physical function, bodily pain, general health, and vitality.
Patients with prostate cancer who were receiving ADT experience worse HRQOL than those not receiving ADT, but duration of ADT was not a contributing factor. After controlling for comorbidity, total testosterone level rather than ADT accounted for a small yet statistically significant percentage of the total variance of the physical health component summary. These findings have important clinical implications regarding the decision to treat prostate cancer patients with ADT.
为研究雄激素剥夺疗法（ADT）对健康相关生活质量（HRQOL）的影响，对接受短期（<6个月）或长期（≥6个月）ADT的前列腺癌患者及健康对照者的自我报告HRQOL进行比较。
横断面研究。
宾夕法尼亚州匹兹堡的学术医疗中心。
96名男性，包括接受短期、长期ADT及未接受ADT的前列腺癌患者和健康对照者。排除正在服用影响骨矿物质代谢药物或患有已知影响骨矿物质代谢疾病的男性。
对每位参与者进行36项简短形式健康调查（一项HRQOL评估）和共病指数评估。在进行HRQOL评估前约3个月或更短时间测量包括身体成分（使用双能X线吸收法评估）和性腺状态（血清总睾酮和游离睾酮）在内的特征。
正如预期，与未接受ADT的男性（即前列腺癌患者和健康对照者）相比，接受ADT的男性睾酮、游离睾酮和瘦体重水平显著更低，体脂和共病指数更高（所有P<0.01）。接受ADT的参与者在身体功能（P<0.001）、总体健康（P<0.001）和身体健康成分总结（P<0.001）方面报告的生活质量显著更差。接受短期或长期ADT的参与者之间的HRQOL结果无显著差异。共病和睾酮水平与几个生活质量量表相关。使用分层回归分析控制共病和总睾酮的显著联合预测因素后，ADT不再是显著预测因素，只有共病和总睾酮有助于解释身体健康成分总结的方差。仅共病有助于解释身体功能、身体疼痛、总体健康和活力方面的方差。
接受ADT的前列腺癌患者的HRQOL比未接受ADT的患者更差，但ADT持续时间不是一个影响因素。在控制共病后，总睾酮水平而非ADT占身体健康成分总结总方差的一小部分但具有统计学意义。这些发现对前列腺癌患者采用ADT治疗的决策具有重要临床意义。
