Nocturia and hot flash interference may partly explain sleep disturbance among men receiving androgen-deprivation therapy (ADT) for prostate cancer (PCa), researchers concluded in a report in Cancer (2018;124:499-506).

Brian D. Gonzalez, PhD, of the Department of Health Outcomes and Behavior at Moffitt Cancer Center in Tampa, Florida, and colleagues compared 78 men with PCa who were placed on ADT with matched groups of 99 men with PCa who underwent radical prostatectomy but not placed on ADT and 108 men with no history of cancer. Compared with controls, ADT recipients spent more time awake after the onset of sleep and reported worse subjective sleep disturbance, more episodes of nocturia, and greater hot flash interference.

Throughout the 12-month study period, ADT recipients also were more likely than controls to report clinically significant sleep disturbance. At baseline and 6 and 12 months, 42%, 50%, and 59% of ADT recipients had clinically significant sleep disturbance (a score of 8 or higher on the Insomnia Severity Index). The proportions among the 2 control groups combined were 21%, 23%, and 26%, respectively, at the same time points.

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After adjustment for comorbidities, education, and race, nocturia mediated the association between ADT and wake and after sleep onset, but not subjective sleep disturbance, whereas hot flash interference significantly mediated the association between ADT and subjective sleep disturbance, but not wake after sleep onset, Dr Gonzalez’s team reported.

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For the study, ADT recipients completed assessments before or within 1 month of starting ADT as well as 6 and 12 months later. The matched controls completed assessments at similar intervals. The investigators assessed comorbidities were assessed using a self-report version of the Charlson Comorbidity Index. They obtained information on baseline Gleason score, height, and weight from medical charts and assessed subjective sleep disturbance in the full sample using the Insomnia Severity Index. This scale assesses the subjective difficulty respondents have in falling asleep and staying asleep, and the impact sleep disturbance has on their daily functioning, the authors explained. They used the Hot Flash Related Daily Interference Scale to assess hot flash interference in the full sample. The scale is a 10-item measure that asks individuals to report the interference on various aspects of functioning associated with hot flashes. Each morning upon waking, participants recorded in a daily diary the number of times they urinated overnight.


Gonzalez BD, Small BJ, Cases MG, et al. Sleep disturbance in men receiving androgen deprivation therapy for prostate cancer: The role of hot flashes and nocturia. Cancer. 2018;124:499-506. doi: 10.1002/cncr.31024