Beer Tomasz M, Shore Neal, Morgans Alicia, Winters-Stone Kerri, Wefel Jeffrey S, George Daniel J
Oregon Health and Science University Knight Cancer Institute Portland Oregon USA.
Carolina Urologic Research Center Myrtle Beach South Carolina USA.
BJUI Compass. 2022 Aug 24;3(6):424-433. doi: 10.1002/bco2.179. eCollection 2022 Nov.
Second-generation androgen receptor inhibitors (ARIs) extend metastasis-free survival, prolong overall survival, and delay symptoms when added to androgen deprivation therapy for the treatment of castration-sensitive or castration-resistant prostate cancer (CRPC). However, ARIs may adversely impact physical and cognitive function, thereby decreasing quality of life and prognosis.
To evaluate the evidence regarding the potential effects of ARIs on physical and cognitive function and to contextualize how drug-related adverse effects may influence treatment decisions in CRPC.
We performed a literature search using MEDLINE from January 1998 to June 2020 using terms relating to prostate cancer, androgen deprivation, and physical and cognitive function. We selected 61 publications for analysis.
Treatment-induced deterioration in physical and cognitive function may impair the independence and well-being of patients with CRPC. Patient-reported outcomes from clinical trials of ARIs provide quantitative evidence of their impact on these domains, which appears to vary between ARIs, reflecting the different adverse event profiles of these agents. Thus, the risk of physical or cognitive dysfunction may be managed or mitigated by appropriate selection of treatment options. Studies in patients with CRPC have assessed the cognitive effects of ARIs with validated instruments, whereas quantitative analysis of the impact on physical function has been limited.
Several validated instruments utilized for the assessment of physical and cognitive function in clinical studies have been adapted for clinical practice; however, consensus on the standardization of these assessments is required. Future clinical studies employing validated tools may generate data on the impact of ARIs and guide treatment decisions for patients with CRPC.
We review the hormonal therapies used to treat men with prostate cancer and the effects they have on physical and cognitive function. We discuss how to measure these effects and how this may assist when choosing treatment.
第二代雄激素受体抑制剂（ARIs）在用于雄激素剥夺治疗以治疗去势敏感性或去势抵抗性前列腺癌（CRPC）时，可延长无转移生存期、延长总生存期并延缓症状出现。然而，ARIs可能对身体和认知功能产生不利影响，从而降低生活质量和预后。
评估有关ARIs对身体和认知功能潜在影响的证据，并阐述药物相关不良反应如何影响CRPC的治疗决策。
我们使用MEDLINE在1998年1月至2020年6月期间进行了文献检索，使用了与前列腺癌、雄激素剥夺以及身体和认知功能相关的术语。我们选择了61篇出版物进行分析。
治疗引起的身体和认知功能恶化可能损害CRPC患者的独立性和幸福感。ARIs临床试验中患者报告的结果提供了其对这些领域影响的定量证据，这在不同的ARIs之间似乎有所不同，反映了这些药物不同的不良事件特征。因此，通过适当选择治疗方案，可以管理或减轻身体或认知功能障碍的风险。CRPC患者的研究已经使用经过验证的工具评估了ARIs的认知影响，而对身体功能影响的定量分析则较为有限。
临床研究中用于评估身体和认知功能的几种经过验证的工具已适用于临床实践；然而，需要就这些评估的标准化达成共识。未来使用经过验证工具的临床研究可能会产生有关ARIs影响的数据，并指导CRPC患者的治疗决策。
我们回顾了用于治疗前列腺癌男性的激素疗法及其对身体和认知功能的影响。我们讨论了如何测量这些影响以及这在选择治疗时可能如何提供帮助。
