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139 Gaps in Patient Knowledge about the Risks and Benefits Associated with Testosterone Replacement Therapy
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Results: Although there was a good correlation between the values obtained by either methodology, at least in terms of rank order, the RIA consistently generated lower absolute values of T. However, and perhaps of more concern was the observation that the apparent underestimation using RIA was more marked as the titers increased. A third lab using alternative LCMS methodology confirmed these trends. Irrespective of methodology weight loss raised T and enclomiphene consistently normalized T producing levels closely mimicking the normal diurnal rhythm. Conclusions: Although routinely and justifiably used, at least on the basis of cost, it is probable that RIA underestimates the absolute levels of T. This could be important from both clinical and regulatory perspectives as it could influence our definition and designation of a patient as a “responder”. Disclosure: Work supported by industry: yes, by Repros Inc (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
139 GAPS IN PATIENT KNOWLEDGE ABOUT THE RISKS AND BENEFITS ASSOCIATED WITH TESTOSTERONE REPLACEMENT THERAPY Gilbert, K.; Cimmino, C.; Beebe, L.; Mehta, A. Emory University, USA Objective: To assess general patient knowledge of the symptoms of testosterone deficiency, and the benefits and risks associated with testosterone replacement therapy (TRT). Material and Methods: An anonymous, 10 question, multiple choice survey was administered to consecutive patients presenting for urologic evaluation at an academic medical center, from December 2015 to April 2016. The survey included questions about perceived symptoms of testosterone deficiency, and the perceived benefits and risks associated with TRT. Patients were also queried as to whether or not that had a diagnosis of testosterone deficiency, and whether they were interested in receiving TRT. Results: The survey response rate was 88% (97/110). The median age group was 41-50 years. 38% of respondents reported a diagnosis of testosterone deficiency by a healthcare provider, while 15% of respondents believed they had testosterone deficiency based on their own research. 43% of respondents reported an interest in TRT. The most commonly reported symptoms of low testosterone were ‘low energy’ (54%), ‘decreased libido’ (51%), ‘weak erections’ (52%) and ‘decreased strength’ (42%). Of the perceived benefits of TRT, the most commonly reported were ‘improved sexual function’ (54%), ‘increased energy’ (53%), and ‘feeling better’ (51%). Half of the respondents were
SMSNA Abstracts
unsure of the risks of testosterone replacement therapy. 21% identified prostate cancer as a risk of TRT. Only 16%, 10%, and 8% of respondents acknowledged the association between TRT and heart attack, stroke, and blood clots, respectively. Several respondents believed TRT increased the risk of balding (4%), kidney failure (3%) and diabetes (3%). Conclusions: There is disproportionate knowledge about the benefits versus the risks associated with TRT among patients. Although 43% of the respondents were interested in receiving TRT, half of respondents were unsure of the risks associated with TRT. These findings indicate an ongoing need for patient education of both the benefits and risks of TRT. Disclosure: Work supported by industry: no. 140 DOES NEOADJUVANT ANDROGEN DEPRIVATION THERAPY IMPACT ERECTILE FUNCTION RECOVERY POSTRADICAL PROSTATECTOMY? Jenkins, L.; Touijer, K.; Rathkopf, D.; Nelson, C.; Mulhall, J. MSKCC, United States Objectives: Androgen deprivation therapy (ADT) has an evolving role in men undergoing radical prostatectomy (RP) with high-risk prostate cancer. Animal research suggests that ADT leads to structural changes in erectile tissue. We looked to identify the impact of ADT on erectile function recovery (EFR) post-RP. Methods: Study population included men: (i) receiving ADT pre-RP for high-risk disease (ii) who completed baseline and follow-up IIEF questionnaires. Follow-up assessment was 18m post RP. Men starting ADT pre-surgery (A) were compared to men who did not receive ADT (N). Patients undergoing salvage RP were excluded. Multivariable analyses (MVA) was used to explore predictors of EFR including were patient age, nerve sparing scores, comorbidity profiles and baseline EFD. Results: 1,089 men met the eligibility criteria. 43 in A group, 1,046 in the N group. Mean age ¼ 59±7 years and vascular co-morbidities were 9% diabetes, 41% hypertension, 43% high cholesterol (no difference between groups). Mean time from RP to last post-RP assessment was 3±1.2 years (range ¼1.5-7 years). No difference in baseline EFD for A vs N groups (25.5±5.1 v 26.2±5.4, p¼0.46). At last follow-up, the A group had a significantly lower EFD score than N group (14±7.7 v 19.2±8.6, p<0.001). On MVA, predicting postRP: baseline EFD, patient age, nerve sparing score, and baseline EFD were all significant predictors (all p values <0.001). ADT was also a significant predictor of post-RP EFD, with A group having a mean EFD score 4.0 points lower than N group (p¼0.002). When assessing men with only good baseline EF (EFD24), the percentage of men
J Sex Med 2017;14:e1ee104
Results: Although there was a good correlation between the values obtained by either methodology, at least in terms of rank order, the RIA consistently generated lower absolute values of T. However, and perhaps of more concern was the observation that the apparent underestimation using RIA was more marked as the titers increased. A third lab using alternative LCMS methodology confirmed these trends. Irrespective of methodology weight loss raised T and enclomiphene consistently normalized T producing levels closely mimicking the normal diurnal rhythm. Conclusions: Although routinely and justifiably used, at least on the basis of cost, it is probable that RIA underestimates the absolute levels of T. This could be important from both clinical and regulatory perspectives as it could influence our definition and designation of a patient as a “responder”. Disclosure: Work supported by industry: yes, by Repros Inc (industry initiated, executed and funded study). The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.
139 GAPS IN PATIENT KNOWLEDGE ABOUT THE RISKS AND BENEFITS ASSOCIATED WITH TESTOSTERONE REPLACEMENT THERAPY Gilbert, K.; Cimmino, C.; Beebe, L.; Mehta, A. Emory University, USA Objective: To assess general patient knowledge of the symptoms of testosterone deficiency, and the benefits and risks associated with testosterone replacement therapy (TRT). Material and Methods: An anonymous, 10 question, multiple choice survey was administered to consecutive patients presenting for urologic evaluation at an academic medical center, from December 2015 to April 2016. The survey included questions about perceived symptoms of testosterone deficiency, and the perceived benefits and risks associated with TRT. Patients were also queried as to whether or not that had a diagnosis of testosterone deficiency, and whether they were interested in receiving TRT. Results: The survey response rate was 88% (97/110). The median age group was 41-50 years. 38% of respondents reported a diagnosis of testosterone deficiency by a healthcare provider, while 15% of respondents believed they had testosterone deficiency based on their own research. 43% of respondents reported an interest in TRT. The most commonly reported symptoms of low testosterone were ‘low energy’ (54%), ‘decreased libido’ (51%), ‘weak erections’ (52%) and ‘decreased strength’ (42%). Of the perceived benefits of TRT, the most commonly reported were ‘improved sexual function’ (54%), ‘increased energy’ (53%), and ‘feeling better’ (51%). Half of the respondents were
SMSNA Abstracts
unsure of the risks of testosterone replacement therapy. 21% identified prostate cancer as a risk of TRT. Only 16%, 10%, and 8% of respondents acknowledged the association between TRT and heart attack, stroke, and blood clots, respectively. Several respondents believed TRT increased the risk of balding (4%), kidney failure (3%) and diabetes (3%). Conclusions: There is disproportionate knowledge about the benefits versus the risks associated with TRT among patients. Although 43% of the respondents were interested in receiving TRT, half of respondents were unsure of the risks associated with TRT. These findings indicate an ongoing need for patient education of both the benefits and risks of TRT. Disclosure: Work supported by industry: no. 140 DOES NEOADJUVANT ANDROGEN DEPRIVATION THERAPY IMPACT ERECTILE FUNCTION RECOVERY POSTRADICAL PROSTATECTOMY? Jenkins, L.; Touijer, K.; Rathkopf, D.; Nelson, C.; Mulhall, J. MSKCC, United States Objectives: Androgen deprivation therapy (ADT) has an evolving role in men undergoing radical prostatectomy (RP) with high-risk prostate cancer. Animal research suggests that ADT leads to structural changes in erectile tissue. We looked to identify the impact of ADT on erectile function recovery (EFR) post-RP. Methods: Study population included men: (i) receiving ADT pre-RP for high-risk disease (ii) who completed baseline and follow-up IIEF questionnaires. Follow-up assessment was 18m post RP. Men starting ADT pre-surgery (A) were compared to men who did not receive ADT (N). Patients undergoing salvage RP were excluded. Multivariable analyses (MVA) was used to explore predictors of EFR including were patient age, nerve sparing scores, comorbidity profiles and baseline EFD. Results: 1,089 men met the eligibility criteria. 43 in A group, 1,046 in the N group. Mean age ¼ 59±7 years and vascular co-morbidities were 9% diabetes, 41% hypertension, 43% high cholesterol (no difference between groups). Mean time from RP to last post-RP assessment was 3±1.2 years (range ¼1.5-7 years). No difference in baseline EFD for A vs N groups (25.5±5.1 v 26.2±5.4, p¼0.46). At last follow-up, the A group had a significantly lower EFD score than N group (14±7.7 v 19.2±8.6, p<0.001). On MVA, predicting postRP: baseline EFD, patient age, nerve sparing score, and baseline EFD were all significant predictors (all p values <0.001). ADT was also a significant predictor of post-RP EFD, with A group having a mean EFD score 4.0 points lower than N group (p¼0.002). When assessing men with only good baseline EF (EFD24), the percentage of men
J Sex Med 2017;14:e1ee104