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Androgen deprivation therapy for prostate cancer causes only modest depression and other side effects

Nearly half of all men with prostate cancer receive androgen deprivation therapy at some point in their course of treatment, since prostate cancer growth is fueled by androgen hormones (especially testosterone). Sexual dysfunction is a well-documented adverse effect of the therapy. Some have also termed the depression, anxiety, malaise, fatigue, and memory difficulties associated with the therapy as "androgen deprivation syndrome." A new study, supported in part by the Agency for Healthcare Research and Quality (HS11618), shows that depression and a range of other cognitive and physical problems affected at least 30 percent of men receiving the therapy over a 5-year period. However, these problems appeared to be primarily due to the older age, greater number of coexisting medical conditions, and more advanced cancers among men receiving androgen deprivation therapy.

The risks of depression and other problems directly attributed to the therapy are at best modest. Thus, they should not preclude its use in men for whom the benefits are clear, conclude the researchers at the University of Texas Medical Branch, Galveston. The researchers analyzed data from the SEER-Medicare database of population-based tumor registries in selected geographic areas. Using a sample of 50,613 men who were diagnosed with prostate cancer from 1992 through 1997, they calculated the risk of physician diagnoses of depression, anxiety, cognitive impairment, or physical symptoms following androgen deprivation.

Of men surviving at least 5 years after prostate cancer diagnosis, 31.3 percent of those receiving androgen deprivation therapy developed at least one depressive, cognitive, or physical diagnosis compared with 23.7 percent of those who did not receive the therapy. Yet, after controlling for tumor characteristics, patient age, and other factors, the risk of developing these problems among the men receiving the therapy was substantially reduced or abolished.

See "Risk of 'androgen deprivation syndrome' in men receiving androgen deprivation for prostate cancer," by Vahakn B. Shahinian, M.D., M.S., Yong-Fang Kuo, Ph.D., Jean L. Freeman, Ph.D., and James S. Goodwin, M.D., in the February 27, 2006, Archives of Internal Medicine 166, pp. 465-471.

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