Quality of life in male patients with hormone-independent cancers: The role of testosterone.

Abstract

9125 Background: Prior studies of quality of life (QoL) in hypogonadal men examined prostate cancer (ca) patients undergoing androgen suppression. This cross-sectional study examines the relationship of hypogonadism to aspects of QoL in patients with hormone independent cancers (HIC). Methods: Serum, demographics, and medical histories were collected from 428 male HIC subjects at 3 cancer centers. Morning blood samples were analyzed for Total Testosterone (TT), Free T, Bio-available T (BAT) and Sex Hormone Binding Globulin. Functional Assessment of Cancer Therapy-Prostate (FACT-P) measured physical, social, emotional and functional domains plus sexual function. Exclusion criteria: <18 yrs, prostate cancer, testicular ca, male breast ca, known hypogonadism, HIV. Multiple regression with backwards selection was used to identify significant, non-redundant predictors of FACT-P subscales. P-value for retention of a predictor was 0.15. Results: Mean age of subjects was 62.1±13.2 years. Median TT was 310 ng/dl (IQR: 190-443, and 196 (48 %) were hypogonadal. BAT showed the strongest univariate relationship with subscales of the FACT-P, correlating significantly with Physical Well-being (PWB), r=0.32, p<0.001; Emotional Well Being (EWB), 0.14, p=0.004; Functional Well-Being (FWB), 0.28, p<0.001; and QoL related to Prostate Ca (QPCa), r=0.37, p<0.001. After controlling for other factors, BAT remained significantly correlated with PWB and QPCa (both p=0.04). There was also a trend between QPCa and hypogonadism (p=0.12). Conclusions: FACT-P subscales show significant correlations with testosterone level. Hypogonadism was not as highly correlated with sexual dysfunction as with fatigue. Hypogonadism was not an independent predictor of sexual dysfunction, which is multi-determined, linked clinically and statistically to other factors, e.g., diabetes, age, opioids. T replacement may improve QoL with amelioration of fatigue. Sexual dysfunction may require co-optimization of glycemia and analgesia. A more specific QoL measure of androgen suppression which is not associated with prostate cancer may better define the correlations.