How to cite: Hahn AW. “How Do We Protect Quality of Life in the Era of Intensification?” Grand Rounds in Urology. August 2026. Accessed Oct 2026. https://grandroundsinurology.com/how-do-we-protect-quality-of-life-in-the-era-of-intensification/
Summary
In this presentation at the UroCancer Interdisciplinary Forum 2026, Andrew W. Hahn, MD, Assistant Professor of Genitourinary Medical Oncology at The University of Texas MD Anderson Cancer Center, Houston, Texas, reviews how clinicians can preserve quality of life while delivering intensified systemic therapy for advanced prostate cancer. Although combination treatment with androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) has significantly improved survival, he emphasizes that prolonged treatment exposure increases the burden of chronic toxicities that require proactive management rather than treatment avoidance.
Dr. Hahn reviews evidence demonstrating that treatment intensification generally does not worsen patient-reported quality of life in randomized clinical trials. However, he notes that real-world patients are typically older, have more cardiovascular comorbidities, and receive therapy for longer durations than trial participants, contributing to a growing disconnect between clinical trial outcomes and population-level survival. He argues that improved management of treatment-related adverse effects may help narrow this gap.
Dr. Hahn discusses both the class effects of ADT and differences among available ARPIs. Common toxicities include fatigue, hot flashes, sexual dysfunction, metabolic syndrome, cardiovascular disease, bone loss, anemia, gynecomastia, and cognitive changes. Because individual ARPIs have distinct pharmacologic characteristics and toxicity profiles, treatment selection should consider patient-specific comorbidities and anticipated tolerability.
Dr. Hahn recommends systematic cardiovascular assessment before initiating therapy, including blood pressure, lipid profile, hemoglobin A1c, and cardiovascular risk evaluation, followed by ongoing monitoring and referral to primary care physicians or cardiologists when appropriate. He similarly advocates routine bone health assessment. He highlights cognitive impairment as an important but underrecognized toxicity.
Dr. Hahn argues that supportive care should evolve alongside treatment intensification. Rather than using toxicity concerns to justify treatment deintensification, clinicians should identify patients at the greatest risk, systematically monitor adverse effects, and intervene early through multidisciplinary management to preserve both survival and quality of life.
ABOUT THE AUTHOR
Andrew W. Hahn, MD, is an Assistant Professor of Genitourinary Medical Oncology at the MD Anderson Cancer Center in Houston, Texas. Dr. Hahn’s research focus is to investigate how host factors influence response, resistance, and toxicity to cancer treatments and to design and run clinical trials to improve outcomes for patients with prostate and kidney cancer. His clinical focus is on prostate and kidney cancers.
