leuprolide and Sexual-Dysfunction--Physiological

To identify the factors underlying prostate cancer (PCa) patients' depression-anxiety, sexual problems, urinary dysfunction and androgen deprivation therapy (ADT)-linked breast changes and hot flushes, and test these as predictors of loss of masculinity (LoM) over 36 months following diagnosis.. One thousand seventy patients from the TROG 03.04 (RADAR) trial the EORTC QLQ C-30 and PR 25 questionnaires, and the International Prostate Cancer Symptom Score of the American Urological Association at baseline, 3, 7, 12, 18, 24 and 36 months. Selected items from these scales were factor-analysed to identify a four-component solution for responses at 18 and 36 months, and these components were regressed against a single-item measuring LoM.. Depression-anxiety factor was the most powerful predictor of LoM at both time points, followed by sexual problems of ADT side effects (breast changes and hot flushes). Urinary dysfunction was not a consistent predictor of LoM. Depression-anxiety was also the most significant factor distinguishing between those men who reported LoM and those who did not.. Although LoM is often reported as arising from ADT, the relative power of depression-anxiety in predicting LoM, both at the selected time points and using a time-lagged analysis, plus the finding that depression-anxiety was the most consistent difference between men who reported LoM and those who did not, argues for the presence of adverse mood states as being the key ingredient in deciding if PCa patients experience loss of their feelings of masculinity.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Androgen Antagonists; Antineoplastic Agents, Hormonal; Anxiety; Depression; Hot Flashes; Humans; Leuprolide; Male; Masculinity; Middle Aged; Prostatic Neoplasms; Sexual Dysfunction, Physiological; Surveys and Questionnaires

To investigate the impacts of leuprolide acetate on the quality of life (QoL) of patients with prostate cancer.. A total of 104 patients was enrolled in this prospective multicenter study. All patients received subcutaneous injections of 3.75 mg leuprolide acetate at 4 week intervals for a total of 12 weeks. QoL was assessed before treatment and at 12 weeks using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and an accompanying prostate cancer-specific module (QLQ-PR25).. Eighty-nine of 104 patients (85.6%) completed the 12 week study. Eighty-six of 89 patients (96.6%) achieved and maintained medical castration. The results of the EORTC QLQ-C30 indicated that patients experienced an improvement in global health status/QoL (p < 0.001), despite a deterioration in physical and role functioning (p = 0.012 and p = 0.007, respectively). The symptom scales indicated a statistically significant improvement in appetite (p = 0.003). The results of the QLQ-PR25 revealed that patients experienced an increase in hot flushes (p < 0.001) and erection problems and uncomfortable sexual intimacy among the sexual functioning items (p = 0.030 and p = 0.023, respectively), but day-time urinary frequency was improved (p = 0.004).. The results of this prospective study indicate that leuprolide acetate treatment was accompanied by improvements in global health status/QoL, despite a deterioration in physical, role and sexual function.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Castration; Chemotherapy, Adjuvant; Hot Flashes; Humans; Leuprolide; Male; Middle Aged; Prospective Studies; Prostatic Neoplasms; Quality of Life; Republic of Korea; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Statistics, Nonparametric; Surveys and Questionnaires; Urination Disorders

Studies fail to find uniform effects of age-related or induced hypogonadism on human sexual function. We examined the effects of induced hypogonadism on sexual function in healthy men and women and attempted to identify predictors of the sexual response to induced hypogonadism or hormone addback. The study design used was a double-blind, controlled, crossover (self-as-own control). The study setting was an ambulatory care clinic in a research hospital, and the participants were 20 men (average+/-SD age=28.5+/-6.2 years) and 20 women (average+/-SD age=33.5+/-8.7 years), all healthy and with no history of psychiatric illness. A multidimensional scale assessing several domains of sexual function was the main outcome measure. Participants of the study received depot leuprolide acetate (Lupron) every 4 weeks for 3 months (men) or 5 months (women). After the first month of Lupron alone, men received (in addition to Lupron) testosterone enanthate (200 mg intramuscularly) or placebo every 2 weeks for 1 month each. Women received Lupron alone for 2 months, and then, in addition to Lupron, they received estradiol and progesterone for 5 weeks each. The results of the study: in women, hypogonadism resulted in a significant decrease in global measures of sexual functioning, principally reflecting a significant decrease in the reported quality of orgasm. In men, hypogonadism resulted in significant reductions in all measured domains of sexual function. Testosterone restored sexual functioning scores in men to those seen at baseline, whereas neither estradiol nor progesterone significantly improved the reduced sexual functioning associated with hypogonadism in women. Induced hypogonadism decreased sexual function in a similar number of men and women. No predictors of response were identified except for levels of sexual function at baseline. In conclusion, our data do not support a simple deficiency model for the role of gonadal steroids in human sexual function; moreover, while variable, the role of testosterone in sexual function in men is more apparent than that of estradiol or progesterone in women.

Topics: Adult; Affect; Dihydrotestosterone; Estradiol; Female; Humans; Hypogonadism; Leuprolide; Male; Middle Aged; Orgasm; Progesterone; Sex Characteristics; Sexual Behavior; Sexual Dysfunction, Physiological; Testosterone

To investigate the effects of different management strategies for non-localized prostate cancer on men's quality of life and cognitive functioning.. Men with prostate cancer were randomly assigned to one of four treatment arms: leuprorelin, goserelin, cyproterone acetate (CPA), or close clinical monitoring. In a repeated-measures design, men were assessed before treatment (baseline) and after 6 and 12 months of treatment. A community comparison group of men of the same age with no prostate cancer participated for the same length of time. The men were recruited from public and private urology departments from university teaching hospitals. All those with prostate cancer who were eligible for hormonal therapy had no symptoms requiring immediate therapy. In all, 82 patients were randomized and 62 completed the 1-year study, and of the 20 community participants, 15 completed the study. The main outcome measures were obtained from questionnaires on emotional distress, existential satisfaction, physical function and symptoms, social and role function, subjective cognitive function, and sexual function, combined with standard neuropsychological tests of memory, attention, and executive functions.. Sexual dysfunction increased for patients on androgen-suppressing therapies, and emotional distress increased in those assigned to CPA or close clinical monitoring. Compared with before treatment there was evidence of an adverse effect of leuprorelin, goserelin, and CPA on cognitive function.. In deciding the timing of androgen suppression therapy for prostate cancer, consideration should be given to potential adverse effects on quality of life and cognitive function.

Topics: Aged; Androgen Antagonists; Antineoplastic Agents, Hormonal; Cognition Disorders; Cyproterone Acetate; Goserelin; Humans; Leuprolide; Male; Prostatic Neoplasms; Quality of Life; Sexual Dysfunction, Physiological; Stress, Psychological

To identify and characterize distinct trajectories of change in young women's sexual functioning over the first 5 years following breast cancer diagnosis.. Group-based trajectory modeling was applied to the sexual functioning of 896 women diagnosed with stage I-IV breast cancer at age 40 or younger. The Cancer Rehabilitation Evaluation System was used to evaluate women's symptoms of sexual dysfunction annually for 5 years.. Five distinct trajectories of sexual functioning were identified: one asymptomatic, one minimally symptomatic, two moderately symptomatic, and one severely symptomatic trajectory. Twelve percent of women were asymptomatic throughout follow-up. The plurality of women experienced stable mild symptoms (42%). Among those with moderate symptoms, some experienced improvement over time (22%) while others experienced deterioration (13%); 11% experienced stable severe symptoms that did not remit over time. Independent predictors of experiencing a symptomatic rather than asymptomatic trajectory (P < 0.05, two-sided) included diagnosis with stage 2 versus 1 disease, ER positive disease treated with oophorectomy or ovarian suppression, being partnered, having anxiety, poorer body image, and greater musculoskeletal pain.. We identified distinct trajectories that describe the reported sexual symptoms in this cohort of young breast cancer survivors. The majority of women reported various degrees of sexual dysfunction that remained stable over the study period. There is, however, potential for improvement of moderate and severe symptoms of sexual dysfunction in early survivorship.

Topics: Adolescent; Adult; Antineoplastic Agents, Hormonal; Anxiety; Body Image; Breast Neoplasms; Cancer Survivors; Cohort Studies; Disease Progression; Female; Humans; Leuprolide; Neoplasm Staging; Ovariectomy; Quality of Life; Receptors, Estrogen; Risk Factors; Severity of Illness Index; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Sexual Partners; Tamoxifen; Young Adult

Luteinizing hormone-releasing hormone (LHRH) agonists have been widely used as effective agents in endocrine therapy for prostate cancer. Continuous administration of the drug results in profound suppression of testicular androgen production. However, the side effects on erectile function have not been fully investigated.. We studied the influences of testosterone suppression on male sexual function and nocturnal penile tumescence in nine sexually active patients with prostate cancer who were treated with an LHRH agonist.. Following reduction of serum testosterone concentrations to a castration level by the administration of the LHRH agonist, sexual desire, sexual interest and sexual intercourse were totally annulled, with significant changes in frequency, magnitude, duration and rigidity of nocturnal erections observed in all patients.. These results demonstrate that the LHRH agonist strongly suppresses erectile function and sexual activity. Taking into account the quality of sexual function for relatively young and sexually active patients and their partners, it is necessary to establish effective modalities that minimize the adverse effects on sexual function for the treatment of patients with prostate cancer.

Topics: Aged; Antineoplastic Agents, Hormonal; Circadian Rhythm; Follow-Up Studies; Gonadotropin-Releasing Hormone; Humans; Injections, Subcutaneous; Leuprolide; Luteinizing Hormone; Male; Middle Aged; Penile Erection; Prolactin; Prostatic Neoplasms; Radioimmunoassay; Retrospective Studies; Sexual Dysfunction, Physiological; Sexuality; Testosterone; Treatment Outcome