Abstract
PurposeTo assess the cognitive and sexual/hormonal functioning of prostate cancer patients treated with a luteinizing hormone-releasing hormone (LH-RH) agonist, and the relationships thereof with adrenal and residual testicular androgen levels.Materials and methodsPreviously, we reported the effect of a luteinizing hormone-releasing hormone (LH-RH) agonist on testicular and adrenal androgen production in patients with prostate cancer. A 6-month treatment with an LH-RH agonist significantly reduced testicular androgens by 90–95% and adrenal androgens by 26–40%. This study evaluated the changes in cognitive and sexual/hormonal functions in the same cohort using the Mini-Mental State Evaluation (MMSE) and Expanded Prostate Cancer Index Composite (EPIC) questionnaire, respectively. In addition, the associations of each function with the serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2), dehydroepiandrosterone-sulfate (DHEA-S), dehydroepiandrosterone (DHEA), androstenedione (A-dione), and cortisol levels were studied.ResultsCognitive functions did not change significantly during the treatment. Sexual functions were relatively low before treatment and worsened significantly after 6 and 12 months of treatment. Interestingly, sexual bothers were improved with the treatment. The treatment significantly worsened hormonal functions and bothers. Regarding specific items in the hormonal domains, hot flashes and body weight changes were the main effects of worsened hormonal function. Low levels of T and E2 and high levels of A-dione were associated with low MMSE scores at 6 months. Regarding sexual and hormonal functions, A-dione, E2, T, cortisol, and DHEA-S were associated with poorer functioning and bother. Especially, low T levels and high E2 levels were the most significant factors associated with worse sexual and hormonal bothers.ConclusionThe LH-RH agonist monotherapy worsened sexual and hormonal functions and hormonal bothers, but not sexual bothers or cognitive functions. The changes in these functions were related to the testicular and adrenal androgens levels.
Highlights
We reported the effect of an luteinizing hormone-releasing hormone (LH-RH) agonist on reducing serum adrenal androgen levels 6 and 12 months after initiating treatment [4]
We evaluated the changes in the healthrelated quality of life (QOL) and cognitive functions using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire [5,6] and Mini-Mental State Evaluation (MMSE) [7]
Patients Previously, we evaluated the serum testicular and adrenal androgen levels in 47 patients with prostate cancer treated via 6-month neoadjuvant androgen-deprivation therapy (ADT) with radiation therapy, followed by adjuvant ADT
Summary
Longterm androgen-deprivation therapy (ADT) is the standard therapy for metastatic prostate cancer and is administered in localized or locally progressive disease concomitant with radiation therapy for the short or long term [1]. ADT has several adverse effects [2,3]. ADT with luteinizing hormone-releasing hormone (LH-RH) analogues is used frequently for medical castration. We reported the effect of an LH-RH agonist on reducing serum adrenal androgen levels 6 and 12 months after initiating treatment [4]. We identified immunoreactive LH receptors in the reticular layer of the adrenal glands and speculated that the LH-RH agonist therapy reduced adrenal androgen synthesis via reduced LH levels [4]
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