Risk of the "androgen deprivation syndrome" in men receiving androgen deprivation for prostate cancer

Vahakn B. Shahinian, Yong Fang Kuo, Jean L. Freeman, James Goodwin

Research output: Contribution to journalArticle

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Abstract

Background: Androgen deprivation therapy for prostate cancer has been associated with a spectrum of adverse effects, such as depression, memory difficulties, and fatigue, termed the androgen deprivation syndrome. Primary care physicians providing follow-up care for men with prostate cancer will be faced with managing these effects. We therefore sought to estimate the incidence of these effects and, by using a control group, ascertain whether these effects were related to androgen deprivation itself. Methods: We assessed the risk of physician diagnoses of depression, cognitive impairment, or constitutional symptoms in Medicare data following androgen deprivation using a sample of 50 613 men with incident prostate cancer and 50 476 men without cancer, from 1992 through 1997, in the linked Surveillance, Epidemiology, and End Results-Medicare database. Cox proportional hazards regression was used to adjust for confounding variables. Results: Of men surviving at least 5 years after diagnosis, 31.3% of those receiving androgen deprivation developed at least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7% in those who did not (P<.001). After adjustment for variables such as comorbidity, tumor characteristics, and age, the risks associated with androgen deprivation were substantially reduced or abolished: relative risk (RR) for depression diagnosis, 1.08 (95% confidence interval [CI], 1.02-1.15); RR for cognitive impairment, 0.99 (95% CI, 0.94-1.04); and RR for constitutional symptoms, 1.17 (95% CI, 1.13-1.22). Conclusion: Depressive, cognitive, and constitutional disorders occur more commonly in patients receiving androgen deprivation, but this appears to be primarily because patients receiving androgen deprivation are older and have more comorbid conditions and more advanced cancers.

Original languageEnglish (US)
Pages (from-to)465-471
Number of pages7
JournalArchives of Internal Medicine
Volume166
Issue number4
DOIs
StatePublished - Feb 27 2006

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Androgens
Prostatic Neoplasms
Confidence Intervals
Depression
Medicare
Neoplasms
Aftercare
Confounding Factors (Epidemiology)
Primary Care Physicians
Fatigue
Comorbidity
Epidemiology
Databases
Physicians
Control Groups
Incidence

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Risk of the "androgen deprivation syndrome" in men receiving androgen deprivation for prostate cancer. / Shahinian, Vahakn B.; Kuo, Yong Fang; Freeman, Jean L.; Goodwin, James.

In: Archives of Internal Medicine, Vol. 166, No. 4, 27.02.2006, p. 465-471.

Research output: Contribution to journalArticle

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abstract = "Background: Androgen deprivation therapy for prostate cancer has been associated with a spectrum of adverse effects, such as depression, memory difficulties, and fatigue, termed the androgen deprivation syndrome. Primary care physicians providing follow-up care for men with prostate cancer will be faced with managing these effects. We therefore sought to estimate the incidence of these effects and, by using a control group, ascertain whether these effects were related to androgen deprivation itself. Methods: We assessed the risk of physician diagnoses of depression, cognitive impairment, or constitutional symptoms in Medicare data following androgen deprivation using a sample of 50 613 men with incident prostate cancer and 50 476 men without cancer, from 1992 through 1997, in the linked Surveillance, Epidemiology, and End Results-Medicare database. Cox proportional hazards regression was used to adjust for confounding variables. Results: Of men surviving at least 5 years after diagnosis, 31.3{\%} of those receiving androgen deprivation developed at least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7{\%} in those who did not (P<.001). After adjustment for variables such as comorbidity, tumor characteristics, and age, the risks associated with androgen deprivation were substantially reduced or abolished: relative risk (RR) for depression diagnosis, 1.08 (95{\%} confidence interval [CI], 1.02-1.15); RR for cognitive impairment, 0.99 (95{\%} CI, 0.94-1.04); and RR for constitutional symptoms, 1.17 (95{\%} CI, 1.13-1.22). Conclusion: Depressive, cognitive, and constitutional disorders occur more commonly in patients receiving androgen deprivation, but this appears to be primarily because patients receiving androgen deprivation are older and have more comorbid conditions and more advanced cancers.",
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