Androgen deprivation therapy for prostate cancer and quality of life: a concept map analysis

Androgen deprivation therapy (ADT) is the backbone of systemic therapy for prostate cancer but is associated with changes that decrease quality of life (QOL). A comprehensive, patient-centered characterization of undesired changes following ADT initiation and their perceived impact on QOL is lacking. We conducted Concept Mapping, a participatory mixed-methods research approach, to identify and categorize changes experienced by patients after starting ADT for prostate cancer.

Thirty men with prostate cancer who started ADT in the preceding 3-12 months were interviewed regarding ADT-related changes. Reported undesired effects were consolidated into a master list of unique items using content analysis, with 79 unique changes experienced after starting ADT. Fifteen participants individually sorted these items into thematic groups and rated each item based on magnitude of negative impact on QOL and desired additional support. A Concept Map was generated by aggregating sorting data and clustering items into domains. The four clusters were named Physical Manifestations, Sexual Changes, Mental Health Changes and Concerns of Stigma, and Motivational Changes. Sexual Changes had the highest mean rating for negative impact on QOL, while Physical Manifestations had the highest mean rating for desired additional support.

Patients experience a wide array of changes after starting ADT, affecting multiple domains of QOL. Many of these changes have not been previously described in the research literature. This patient-centered framework can inform clinical practice, support intervention development, and provide anticipatory guidance for patients initiating ADT.