SAN FRANCISCOA comparison of quality-of-life measures
reported by patients in the Prostate Cancer Outcomes Study (PCOS) found that
men who underwent orchiectomy felt better and worried less about their health
than men who received luteinizing hormone-releasing hormone (LHRH) agonists.
Kevin B. Knopf, MD, MPH, presented results of the National
Cancer Institute study of 431 men who underwent primary androgen deprivation
therapy while participating in PCOS. The researchers found orchiectomy and LHRH
patients had equivalent health outcomes for urinary, bowel, and sexual
function. For example, 85.1% of orchiectomy patients and 83.9% of the LHRH
patients reported posttreatment impotence.
Nonetheless, the LHRH patients reported more physical
discomfort than the orchiectomy patients, in particular breast swelling, 24.9%
vs 9.7%, and were more likely to rate their health as fair or poor: 35.4% vs
28.1%. (See Figures 1 and 2.)
"Both groups felt satisfied with their treatment, although
the men who received LHRH agonists tended to have more worry and distress
overall about their cancer and were less likely to perceive themselves as being
free of prostate cancer," said Dr. Knopf. Now at the Annapolis Cancer
Center in Maryland, at the time of the study he was an oncology and research
fellow in the applied research program at NCI, where he collaborated with
health services researcher Arnold L. Potosky, PhD.
High Risk of Progression
The patients in the study came from six geographic regions.
More than half were initially diagnosed with localized prostate cancer. About
one third of the men had metastatic disease, according to Dr. Knopf.
"The prevalence of androgen deprivation therapy was higher
in localized prostate cancer than one would have thought," he said, noting
that it is not indicated as the primary treatment for localized disease. If the
numbers reflect its use nationwide, Dr. Knopf estimated that 22,000 men in
America could be receiving primary androgen therapy for localized prostate
All told, 3,486 men diagnosed with primary invasive prostate
cancer from October 1, 1994, through October 31, 1995, participated in PCOS. Of
these, 2,350 men received androgen deprivation therapy in addition to radiation
or surgery and 714 men had radiation or surgery without any androgen therapy,
according to Dr. Knopf. Another subset of 45 men who received oral monotherapy
was too small to be included, he said.
The researchers analyzed questionnaires sent at 6, 12, and 24
months after diagnosis to the remaining 431 men who only received hormone
therapy. Dr. Knopf used the 12-month data in his presentation, noting that it
was virtually identical to the 24-month data.
He reported that LHRH was more common than orchiectomy, 299
patients vs 132, in this cohort. At baseline LHRH patients were better educated
and wealthier, with a larger proportion of incomes above $30,000: 35% vs 21%.
Orchiectomy patients were more likely to have obstruction, 61% vs 44%. The
median age for both groups was 73, and their sexual function was similar at
More Into Denial?
In discussing the study, Mark S. Litwin, MD, MPH, of the
University of California, Los Angeles, suggested that the researchers might
have identified underlying differences between patients in the two groups
rather than in the effects of the treatments. "It may be that orchiectomy
patients are more into denial and don’t really want to think about their
disease," he said. "It may be that LHRH patients end up being more
the worrywarts, if you will. They may end up getting more PSAs measured. It may
be that the patients who undergo orchiectomy may find it easier to just carry
on with their lives and not think about things."
Dr. Knopf said he could not explain why the LHRH patients
worried more about their health, but he offered a hypothesis. "Men who
chose shots may have been more cognizant of the disease from the start,"
he said, adding that they might be more concerned about their disease because
they went to the doctor’s office more often for their treatment.