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Sleep disturbance in men receiving androgen deprivation therapy for prostate cancer: The role of hot flashes and nocturia
Gonzalez BD, Small BJ, Cases MG et al.
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Commentary by Antonella Giannantoni
In the present article the Authors investigated the contribution of common side effects of prostate cancer treatment, as nocturia and hot flashes, to sleep disturbances in patients treated with androgen deprivation therapy (ADT). In their study, the Authors hypotesized that patients treated with ADT are affected by worse sleep disturbance and nocturia compared with cases undergone only surgery, or compared with cases without cancer. It is well known that ADT for prostate cancer induces hot flashes, muscle loss, fatigue, depression, and cognitive impairment. In addition, the drastic reduction in the blood levels of testosterone, as induced by ADT, may be responsible for the emergence of nocturia, due to the loss of the regulatory function of testosterone on vasopressin levels.
In the study, 78 patients with prostate cancer were assessed before or within 1 month after the initiation of ADT, as well as 6 months and 12 months later. Patients with prostate cancer treated with prostatectomy only (99 patients) and men with no history of cancer (108 men) acted as controls and were assessed at similar intervals. Sleep disturbances were investigated with the recording of the Insomnia Severity Index, and interference from hot flashes with the Hot Flash Related Daily Interference Scale. One hundred participants also wore actigraphs for 3 days at the 6-month evaluation to measure objective sleep disturbance and recorded their nocturia frequency.
As results, ADT patients demonstrated a trend toward higher rates of clinically significant sleep disturbance at each assessement compared with controls. In addition, patients treated with androgen deprivation therapy reported greater hot flash interference over time and experienced significantly worse wake after sleep onset and nocturia compared with controls.
Overall, the study demonstrates for the first time that patients with prostate cancer treated with ADT spent more time awake after the onset of sleep and reported worse subjective sleep disturbance than matched controls, more episodes of nocturia, and greater hot flash interference.
The results of the present study may be really helpful for clinicians involved in the treaatment of patients with prostate cancer and allow to choose the best therapeutic option in order to reduce ADT therapy side effects, particulalrly sleep deprivation and nocturia.