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Androgen-deprivation therapy (ADT) has become the mainstay of treatment for metastatic prostate cancer. ADT's testosterone depletion, however, leads to side effects that impair health-related quality-of-life.

"Equipped with effective mitigation strategies and possible alternatives, clinicians and researchers can optimize health-related quality of life for patients currently receiving ADT for prostate cancer and consider treatments that spare patients from adverse events of ADT," said Lisa Gudenkauf, PhD, of Moffitt Cancer Center in Tampa, Florida, and colleagues, writing in a review in the

They reviewed and evaluated behavioral interventions to address common side effects including fatigue, depression, sleep disruption, and sexual dysfunction, and also discussed agents to mitigate bone loss and alternative ADT-sparing treatments.

Gudenkauf, a clinical psychologist and applied research scientist, dove deeper into some of these strategies in the following interview.

Physical activity has been shown to improve fatigue, sexual function, and overall quality of life. In 2014, the American Cancer Society recommended that patients with prostate cancer engage in at least 150 minutes of physical activity per week. Since then, more physical activity intervention trials have emerged. What have these new trials shown?

Gudenkauf: We used to focus primarily on aerobic exercise for individuals diagnosed with cancer. We now know that resistance training is also important. We have evidence from randomized controlled trials to show that the combination of aerobic and resistance training is especially beneficial in the context of ADT. These trials have shown that combined aerobic and resistance training programs improve muscle mass, strength, physical function, and balance for patients with and without bone metastases who are treated with ADT.

Of the treatments being studied to mitigate the effects of ADT, which do you find most promising and why?

Gudenkauf: I am admittedly biased as a clinical health psychologist, but I really believe in the promise of behavioral interventions. We have a large toolbox of evidence-based behavioral strategies that really work, many of which we describe in the article. One of the challenges we face is getting these behavioral strategies to the patients most in need. Broad dissemination and implementation of behavioral strategies remain severely limited.

My hope, and what our work strives toward, is to increase patient access to evidence-based behavioral interventions. Many of these behavioral interventions are poised for scalable, cost-effective delivery across the U.S. and beyond and hold substantial promise for improving patient quality of life.

Can you give an example from your own experience of a patient with adverse events from ADT and the approaches used to address this?

Gudenkauf: I have worked with many different patients dealing with various adverse effects of ADT. Changes in sexual functioning can be particularly challenging for patients and can negatively impact day-to-day living, relationships, and an individual's sense of identity.

In my clinical work, I used evidence-based therapies, including cognitive-behavioral therapy and sensate focus approaches, to help patients learn to self-manage distress related to sexual functioning changes, effectively communicate with others, and sometimes redefine what sexuality and intimacy mean to them. I've seen these evidence-based therapies work for patients and really improve their quality of life.

Tell us about some of your research on patient-reported outcomes and quality of life for patients with prostate cancer.

Gudenkauf: One of our recent projects on patient-reported outcomes has been the for patients with metastatic castrate-resistant prostate cancer receiving radionuclide therapy. We recognized the critical need to understand tolerability of this novel therapy and to give patients a voice in directly reporting the symptoms and toxicities they experience.

Through a multi-step process involving input from patient, caregiver, and clinician stakeholders, we developed a brief patient-reported outcome measure called the (FACT-RNT) to monitor these symptoms and toxicities. The FACT-RNT is already being implemented in clinical trials and clinical practice around the world with the ultimate goal of improving patient quality of life.

Read the review here.