Sex or survival

Derek R. Wilke, Murray Krahn, George Tomlinson, Andrea Bezjak, Robert Rutledge, Padraig Warde
2010 Cancer  
BACKGROUND: Combined long-term androgen deprivation (LTAD) and radiation conveys a prostate cancer-specific survival advantage over combined short-term androgen deprivation (STAD) and radiation. The seminal question is whether or not the gains are worth the adverse effects of LTAD with respect to patient preferences. METHODS: Preferences for LTAD compared with STAD were elicited by direct patient interview using the probability trade-off method. "Time trade-off utilities" (TTOu) for erectile
more » ... function and osteoporosis were elicited using the time tradeoff method. Participants' current prostate cancer-specific health state was assessed using the Patient-Oriented Prostate Utility Scale-Psychometric. Participants' current sexual function was assessed using the International Index of Erectile Function (IIEF). RESULTS: All participants were willing to trade survival rather than undergo LTAD compared with STAD. The mean minimally required increment in prostate cancer-specific survival (MRIS) was 8.2%. The mean TTOu for impotence was 0.78, and the mean TTOu for osteoporosis was 0.71. The MRIS was correlated with the Sexual Desire domain score of the IIEF (Spearman rank-correlation coefficient, r ¼ 0.50; P<.0001). CONCLUSIONS: Patients desired more prostate cancer-specific survival than what was afforded by LTAD and radiotherapy compared with STAD and radiotherapy. Despite the shift to earlier prostate cancer stage at diagnosis that has been observed in the prostate-specific antigen (PSA) era, 1 significant numbers of men still present with locally advanced disease at the time of diagnosis. Recommended treatment for these patients includes some combination of androgen deprivation (usually luteinizing-hormone releasing hormone agonist [LHRHa] monotherapy) and external-beam radiotherapy. 2 An important area of controversy is the optimal duration of androgen-deprivation therapy. Long-term androgen deprivation (LTAD) for durations 28 months, improves prostate cancer-specific survival compared with short-term androgen deprivation (STAD) or radiotherapy alone. 3-6 However, compared with STAD, to date, randomized studies of LTAD have not demonstrated an improvement in overall survival, except in a subgroup of patients who have Gleason scores between 8 and 10. 4,5 However, LTAD does result in a significant decrease in quality of life 7-9 and can produce anemia, 10,11 osteoporosis, 12,13 weight gain, fatigue, 14 and profound lack of sexual desire and erectile function. 15 Faced with this situation, some patients may be willing to accept a shorter life expectancy in exchange for a good health-related quality of life (HRQOL). In the study by Singer et al, 16 who used the probability trade-off technique (PTO), 68% of study participants (older men without prostate cancer) were willing to trade an improvement 10% in 5-year survival to maintain potency when they were presented with a hypothetical situation comparing radical prostatectomy versus radiotherapy for localized
doi:10.1002/cncr.24905 pmid:20162716 fatcat:d7rqxrissvh3tnzo5cx3bypzo4