This prospective observational study will evaluate quality of life, functional status, and cognitive outcomes in men with metastatic hormone-sensitive prostate cancer (mHSPC) receiving androgen receptor pathway inhibitors (ARPIs) in addition to standard androgen deprivation therapy. ARPIs in this study include abiraterone acetate, apalutamide, enzalutamide, and darolutamide, depending on local availability. A total of 102 patients will be enrolled from two academic oncology centers in Türkiye. Participants will be assessed at baseline, 3 months, and 6 months using validated Turkish versions of established questionnaires: Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), Functional Assessment of Cancer Therapy-Fatigue (FACT-F), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI). Clinical parameters, ECOG performance status, routine laboratory results, and treatment-related adverse events will also be recorded. The primary outcomes are longitudinal changes in FACT-Cog and FACT-F scores. Secondary outcomes include changes in depression, sleep quality, laboratory results, and adverse events. This study will provide real-world evidence on how ARPI therapy affects cognitive health and quality of life in patients with mHSPC.
Metastatic hormone-sensitive prostate cancer (mHSPC) is a disease stage in which systemic treatment strategies significantly affect survival, functional status, and quality of life. The incorporation of androgen receptor pathway inhibitors (ARPIs) into clinical practice has improved oncological outcomes, yet their influence on cognitive function, fatigue, mood, and sleep requires further real-world investigation. In this study, the term androgen receptor pathway inhibitors (ARPIs) refer to abiraterone acetate, apalutamide, enzalutamide, and darolutamide. While abiraterone, apalutamide, and enzalutamide are widely used in routine practice in Türkiye, darolutamide may also be included when accessible. All patients will receive ARPIs in combination with standard androgen deprivation therapy (ADT). This prospective, multicenter, observational cohort study will enroll 102 patients with newly diagnosed mHSPC at Ankara Etlik City Hospital and Gazi University. Assessments will take place at baseline, 3 months, and 6 months. Validated Turkish patient-reported outcome instruments will be applied: FACT-Cog: score range 0-148; higher scores = better cognitive functioning. FACT-F: score range 0-52; higher scores = less fatigue. PHQ-9: score range 0-27; cut-offs: 5 (mild), 10 (moderate), 15 (moderately severe), 20+ (severe depression). PSQI: score range 0-21; global score \>5 indicates poor sleep quality. Additional measures will include ECOG performance status (0-5; higher = worse functioning), demographic and clinical characteristics, comorbidities, and routine laboratory tests. Treatment-related adverse events will be recorded according to CTCAE criteria. The primary outcomes are longitudinal changes in FACT-Cog and FACT-F scores between baseline, 3 months, and 6 months. Secondary outcomes include changes in PHQ-9 and PSQI scores, ECOG performance status, and laboratory results, as well as adverse event profiles. Exploratory analyses will assess the relationship between clinical or laboratory variables and patient-reported outcomes. Statistical analyses will include descriptive statistics, group comparisons, and repeated-measures modeling. Multivariable regression will be applied to identify predictors of impaired cognitive or functional outcomes. By incorporating validated Turkish instruments and explicitly defining ARPI agents, this study aims to generate robust real-world evidence on the cognitive, functional, and quality-of-life effects of ARPI therapy in mHSPC. The findings are expected to guide supportive care strategies and optimize treatment decision-making.
Study Type
OBSERVATIONAL
Enrollment
102
Men with metastatic hormone-sensitive prostate cancer will receive androgen receptor pathway inhibitors (abiraterone acetate, apalutamide, enzalutamide, or darolutamide) in addition to standard androgen deprivation therapy. The choice of ARPI will be determined by routine clinical practice. The study does not assign treatments; it observes patient outcomes under real-world conditions.
Etlik City Hospital Medical Oncology Department
Ankara, Yenimahalle, Turkey (Türkiye)
RECRUITINGGazi University Medical Oncology Department
Ankara, Çankaya, Turkey (Türkiye)
RECRUITINGChange From Baseline in Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog) Total Score
FACT-Cog total score ranges from 0 to 148, with higher scores indicating better cognitive functioning. Both continuous change (follow-up minus baseline) and categorical decline (≥10-point decrease from baseline, indicating clinically meaningful cognitive deterioration) will be assessed.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Functional Assessment of Cancer Therapy - Fatigue (FACT-F) Score
FACT-F total score ranges from 0 to 52, with higher scores indicating less fatigue burden (better status). Both continuous change and categorical threshold (FACT-F ≤34 = clinically significant fatigue) will be evaluated.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Patient Health Questionnaire-9 (PHQ-9) Depression Score
PHQ-9 total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms. Both continuous change and categorical threshold (PHQ-9 ≥10 = moderate-to-severe depression) will be reported.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Pittsburgh Sleep Quality Index (PSQI) Global Score
PSQI global score ranges from 0 to 21, with higher scores indicating poorer sleep quality. Both continuous change and categorical threshold (PSQI \>5 = poor sleep quality) will be assessed.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Eastern Cooperative Oncology Group (ECOG) Performance Status
ECOG performance status ranges from 0 (fully active) to 4 (completely disabled), with higher scores indicating worse functional status. Both continuous change and categorical threshold (≥1-point worsening = functional decline) will be evaluated.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Liver Function Parameters
Change in serum AST (U/L), ALT (U/L), total bilirubin (mg/dL), and alkaline phosphatase (U/L). Higher levels reflect worsening liver function. Continuous values will be reported.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Renal Function Parameters
Change in serum creatinine (mg/dL) and estimated glomerular filtration rate (eGFR, mL/min/1.73 m²). Higher creatinine and lower eGFR reflect worse renal function. Continuous values will be reported.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Electrolyte Levels
Change in serum sodium, potassium, calcium, and other routine electrolytes (mmol/L). Both increases and decreases outside the normal reference range will be noted. Continuous values will be reported.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
Change From Baseline in Complete Blood Count (CBC)
Change in hemoglobin (g/dL), white blood cell count, neutrophils, lymphocytes, and platelet count (×10⁹/L). Both continuous changes and categorical thresholds (e.g., anemia = hemoglobin \<12 g/dL) will be reported.
Time frame: Baseline, 3 months, and 6 months after treatment initiation
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