Patients with advanced prostate cancer have to cope with a number of stresses and other issues that are related to their disease and its treatment, such as side effects from androgen deprivation therapy. Recently introduced and emerging therapies (ie, second-generation antiandrogens) are being developed with those side effect burdens in mind. There is a role for tailoring these agents and their distinct profiles to the individual patient, but there is also an overriding principle that not every patient with nonmetastatic castration-resistant prostate cancer needs to be treated. QOL may be impacted by treatment, but there are a few other influences, such as social support and physical activity, that may be of great importance in QOL as well.

Family and social support are often key in this regard. Several studies have shown increased survival among men with prostate cancer who were married vs those who were unmarried. Additionally, there has been a strong impetus recently to encourage patients with prostate cancer, especially those receiving androgen deprivation therapy, to maintain as normal a lifestyle as possible and to be physically active. Exercise is beneficial, and weight training helps maintain muscle mass and bone mineral density. We work together with our advanced practitioners on these efforts, and we have patient education materials available that convey the importance of maintaining a normal, healthy lifestyle when going on androgen deprivation therapy. This is a need that has been recognized, and we are spending much more time on encouraging QOL maintenance through exercise and other social engagements.

Unfortunately, there are several reports of increased rates of cardiovascular death and suicide among men with prostate cancer soon after they are diagnosed. Again, this reinforces the importance of social, psychological, and family support. It is also important to remember that androgen deprivation therapy may have a negative impact on a variety of comorbidities, such as diabetes and hypercholesterolemia. Overall health and well-being are connected to QOL, and partnerships with primary care providers and other specialists can help ensure that all of a patient’s health concerns are being addressed (eg, sarcopenia, dyslipidemia, hyperglycemia). As relates to depression, in many cases, advanced practitioners might notice a difference in the patient’s mood, or perhaps family members will report that the patient’s mood has changed. Additionally, there are questionnaires available to help identify patients who may be under psychological distress and would benefit from psychological support. Primary care physicians routinely prescribe antidepressant medications, but, unfortunately, patients may not receive the full benefit of pharmacotherapy together with counseling when insurance carriers do not cover the latter.