Improving Quality of Life of Prostate Cancer Survivors with Androgen Deficiency

摘要 前列腺癌(PCA)患者存活率的显著提高使人们的注意力集中在 性功能障碍、身体功能障碍和低能量的流行，这些都是导致 前列腺癌幸存者的次优健康相关生活质量(HRQOL)。它们的病理生理学 前列腺癌幸存者的症状是多因素的，但雄激素缺乏是一种常见的、可治愈的症状。 贡献者。在性腺功能低下的健康男性中，睾酮替代疗法(TRT)可以改善这些症状， 这表明它可能也适用于患有睾丸素缺乏的前列腺癌幸存者。然而，因为 睾酮促进转移性前列腺癌的生长，一直有人担心给药 前列腺癌幸存者的TRT。开放标签试验和回顾分析的报告非常低 接受根治性前列腺切除术和TRT但既不安全也不安全的男性的复发率 疗效已经在该人群的随机试验中进行了评估。西南肿瘤组患者 倡导者认为这是前列腺癌幸存者的一个高度优先的问题。 我们的主要目标是进行一项双盲、安慰剂对照、平行分组的随机试验，以确定 睾酮替代治疗是否安全有效地改善男性雄激素患者的性功能 因PT2，N0，M0，Gleason Score≤6疾病接受过根治性前列腺切除术，并在 疾病复发的风险非常低。第二个目标是确定TRT是否可以改善肌肉质量和 力量，自我报告和以表现为基础的身体机能测量。第三个目标是 确定TRT对幸福感、情感、情绪、精力和生活质量的影响。审判将招募男性， 40岁或以上，曾因器官局限性前列腺癌接受根治性前列腺癌切除术(pt2，n0，m0)； Gleason Score≤6；治疗前PSA10 ng/mL；以及至少两次不可检测的PSA0.1 ng/mL 前列腺癌根治术后数年；有性功能障碍、疲劳或身体功能障碍症状的人； 他们的总睾丸素(平均两个早晨的水平为275 ng/dL)或游离睾丸素(60 ng/dL)明显较低 Pg/m L)水平。参与者将被随机接受为期12周的安慰剂或睾丸素凝胶治疗。中的更改 性活动、性欲、勃起功能、性困扰、性生活质量、瘦体重、肌肉 在基线、6周和12周时对力量、身体功能、情感平衡和能量进行评估。我们 将监测红细胞压积、前列腺特异性抗原和生化复发，定义为“PSA0.2 ng/mL的≥与确认性 ≥水平为0.2ngmL.“。仔细选择复发风险极低的受试者，严格的安全监测， 预先指定的停止规则，以及由独立的DSMB进行监督，将把风险降至最低。广泛的初步 数据支持这一试验的可行性。随机试验设计，多学科团队，认真关注 统计能力，以及选择有症状的睾丸素水平明显偏低的男性将确保有效性 评估睾酮治疗在这一贫困患者群体中的有效性和安全性。

SUMMARY Substantial improvement in survival in men with prostate cancer (PCa) has focused attention on the high prevalence of sexual dysfunction, physical dysfunction, and low energy, which are important contributors to suboptimal health-related quality of life (HRQOL) in prostate cancer survivors. The pathophysiology of these symptoms in prostate cancer survivors is multifactorial, but androgen deficiency is a frequent, remediable contributor. In healthy hypogonadal men, testosterone replacement therapy (TRT) improves these symptoms, suggesting that it also might do so for survivors of PCa who have testosterone deficiency. However, because testosterone promotes the growth of metastatic prostate cancer, there has been concern about administering TRT to prostate cancer survivors. Open label trials and retrospective analyses have reported very low recurrence rates in men who have undergone radical prostatectomy and received TRT, but neither safety nor efficacy have been evaluated in a randomized trial in this population. The South West Oncology Group patient advocates have deemed this a high priority question for prostate cancer survivors. Our primary aim is to conduct a double-blind, placebo-controlled, parallel-group, randomized trial to determine whether testosterone replacement is safe and efficacious in improving sexual function in men with androgen deficiency, who have undergone radical prostatectomy for pT2,N0,M0, Gleason score ≤6 disease and are at very low risk of disease recurrence. A secondary aim is to determine whether TRT improves muscle mass and strength, and self reported and performance-based measures of physical function. The third objective is to determine the effects of TRT on wellbeing and affect, mood, energy, and quality of life. The trial will enroll men, 40 years or older, who have undergone radical prostatectomy for organ-localized prostate cancer (pT2,N0,M0); with Gleason score ≤6; pre-treatment PSA <10 ng/mL; and undetectable PSA (<0.1 ng/mL) for at least two years after radical prostatectomy; who have symptoms of sexual dysfunction, fatigue, or physical dysfunction; and who have unequivocally low total (average of two morning levels <275 ng/dL) or free testosterone (<60 pg/mL) levels. Participants will be randomized to receive placebo or testosterone gel for 12 weeks. Changes in sexual activity, sexual desire, erectile function, sexual distress, sexual life quality, lean body mass, muscle strength, physical function, affectivity balance, and energy will be evaluated at baseline, 6 and 12 weeks. We will monitor hematocrit, PSA, and biochemical recurrence, defined as” PSA of ≥0.2 ng/mL with a confirmatory level of ≥0.2 ng/mL”. Careful selection of subjects with very low risk of recurrence, rigorous safety monitoring, pre-specified stopping rules, and oversight by an independent DSMB will minimize risks. Extensive preliminary data support the feasibility of this trial. Randomized trial design, a multidisciplinary team, careful attention to statistical power, and selection of symptomatic men with unequivocally low testosterone will insure the validity of the assessment of efficacy and safety of testosterone therapy in this needy patient population.