Androgen deprivation therapy (ADT) is increasingly being used to treat prostate cancer in the neoadjuvant and adjuvant contexts with radiation therapy (RT), for recurrence following primary treatment with surgery or radiation, or when the prostate cancer is at an advanced stage such that local treatments, surgery or radiation, are no longer indicated. This is significant because prostate cancer is the most commonly diagnosed noncutaneous cancer in American men. Of particular concern are underserved men. Latinos are the fastest growing minority in the United States (US) and have lower rates of health insurance coverage. African American (AA men) have almost twice the incidence as men of other ethnicities, and have advanced, aggressive disease. For purposes of this study, we will define underserved as low-income and uninsured or publically insured. Low-income will be household income 300% of the Federal Poverty Level (FPL) or less. Despite the proven survival benefit of ADT relative to prostate cancer, studies have shown that men on ADT are at increased risk for vasomotor symptoms, depression, fatigue, diminished health-related quality of life (HRQOL), decreased bone mineral density (BMD), sexual dysfunction, metabolic syndrome, increased fat mass, along with decreased lean muscle mass, increased serum lipids, and decreased arterial compliance all of which places them at higher risk for cardiovascular disease (CVD), osteoporosis, and type II diabetes. Both Latinos and AA more often have components of metabolic syndrome, obesity, dyslipidemia, low cardiovascular fitness, and diabetes placing them at higher risk for CVD. However, little is known about how these men understand ADT and its associated risks relative to their own health and well-being. Therefore, we aim to: 1. From previously collected data explore men's explanations of ADT, its purpose, effects, and risks among underserved men on ADT in order to develop interview guides focused on issues related to 2 Elicit in-depth narratives from underserved men on ADT focused on their understanding and experience of ADT and 3. Develop a descriptive framework of men's understanding of and response to ADT and its associated risks to guide development of interventions to decrease morbidity and mortality related to ADT-associated risks. We will use a two-stage qualitative approach to meet these aims. First we will conduct a new, in-depth analysis of existing qualitative data focused on men who were receiving ADT at the time of their interviews. From this analysis we will develop focused interview guides to more completely explore men's understanding and management of ADT-related with a new cohort of underserved men. This is necessary formative work to lay the foundation for the development and testing of interventions to minimize ADT-associated risks among highly vulnerable underserved men. These interventions have the potential to improve morbidity and mortality of underserved men on ADT thereby decreasing some of the health care and human costs that can be associated with ADT.

Public Health Relevance

While androgen deprivation therapy (ADT) has survival benefit for men with recurrent of advanced prostate cancer, it has multiple associated risks related to cardiovascular disease, bone fraction, metabolic syndrome, and sexual dysfunction. Underserved men are at particular risk. Our goal is to understand how underserved men treated for prostate cancer with ADT understand their treatment and the risks associated with it. To do this, we will conduct the study in two phases. In the first phase we will use transcripts of interviews conducted with underserved men in two studies;one on the meaning of prostate cancer treatment-related incontinence and impotence among low-income African American and Latino men and the second on the impact for prostate cancer treatment-related symptoms on low-income Latino couples. We will select the transcripts of the men who were on ADT and re-analyze them for understanding of ADT and its risks and for their management of related symptoms. We will use this to develop an interview guide to do in-depth interviews focused on ADT understanding and risks. We will use the analysis of this data to help develop interventions to minimize ADT-related risks.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Grants (R21)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Cotton, Paul
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University of California Los Angeles
Schools of Nursing
Los Angeles
United States
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