Quantifying the short-term gains in health-related quality of life from androgen deprivation therapy in metastatic hormone-naïve prostate cancer

Background Metastatic prostate cancer (mPCa) is associated with poor quality of life. A goal of the management of the condition is to improve the health-related quality of life (HRQoL). This study aims to quantify the gain in the HRQoL in the first 6 months of androgen deprivation therapy (ADT) for mPCa. The gain from non-surgical ADT is compared against that from surgical ADT. Methods Men scheduled for ADT for mPCa were recruited. Age, body mass index (BMI), Eastern Cooperative Oncology Group performance status (ECOG-PS) and prostate-specific antigen (PSA) were determined. Functional Assessment in Cancer Therapy – Prostate (FACT-P) and EuroQol EQ-5D-5 L questionnaires were administered at recruitment and at 6 months of ADT. The Ugandan health value set was used to derive health utility indices (HUI) from the responses in the EQ-5D-5 L questionnaire. Change in the FACT-P scores and in the HUI in the first 6 months of ADT were determined. An age-matched control group of men with non-malignant, non-debilitating health conditions was recruited also. Results There were 224 and 185 participants in the ADT and control groups respectively. The participants in the 2 groups were similar in age (p 0.07) and level of formal education (p 0.30). The ADT group reported lower HRQoL from the derived HUI ( p < 0.001). The mean FACT-P score in the ADT group was 80.18 ± 17.56. At 6 months of ADT, the median utility derived was 0.13(IQR 0.07–0.24) and the QALYs gain was 0.31 ± 0.13. Non-surgical ADT with gonadotropin-releasing hormone analogue (GnRHa) and surgical ADT by bilateral total orchidectomy (BTO) achieved similar decrease in PSA ( p = 0.49), gain in BMI ( p = 0.26) and increase in FACT-P score at 6 months ( p = 0.59). In addition, both modalities achieved similar utilities and gains in QALYs. Conclusion There is evidence that ADT is effective in inducing symptom remission and improving HRQoL in metastatic prostate cancer in the short term. Irrespective of the modality of ADT deployed, the utility and the QALYs gain are similar.