Treatment of prostate cancer with GnRH agonists: what is the real impact on quality of life?

By Lila Rouland | Published on November 17, 2025 | 3 min read


Prostate cancer is one of the most common cancers in men. In advanced stages, treatment often relies on hormone therapy using GnRH (gonadotropin-releasing hormone) agonists. While this approach slows tumor progression by suppressing testosterone, it also causes significant side effects that may impair quality of life (QoL). Fatigue, mood disturbances, hot flashes, and decreased libido are among the most frequently reported complaints. The PRISME study, a French multicenter observational project, aimed to precisely measure the evolution of QoL in patients starting GnRH agonist therapy under real-world clinical conditions.  

Quality of life under GnRH therapy: apparent stability or hidden decline?  

Methodology: a 6-month real-life follow-up

The study included 603 patients aged 50 or older with locally advanced or metastatic prostate cancer who were initiating hormone therapy with GnRH agonists (mainly leuprorelin or goserelin). Patients were assessed at baseline (M0), month 3 (M3), and month 6 (M6). QoL evaluation was based on validated EORTC questionnaires: QLQ-C30 and QLQ-PR25, exploring functional domains, symptoms, and prostate-cancer-specific dimensions.

A globally stable quality of life at 6 months

Contrary to some earlier studies, global quality of life (QLQ-C30 score) remained stable between M0 and M6, with no significant deterioration. Physical, social, emotional, and cognitive function scores also remained stable, suggesting overall good tolerability of the treatment.

However, this apparent stability conceals important individual variations. Approximately 30% of patients experienced a notable decline in QoL in at least one functional domain. These patients often had bone involvement, received concomitant anticancer treatments (such as radiotherapy), or had low baseline QoL.  

Worsening of symptoms related to hormone deprivation

Despite overall functional stability, certain symptoms specific to hormonal therapy increased significantly, including:

• Hot flashes: reported by 43% of patients at M6 (vs 29% at M0)
• Fatigue: slight increase
• Sexual dysfunction: declining QLQ-PR25 scores
• Loss of libido and worsening erectile dysfunction were also more pronounced

These expected side effects highlight the need for adapted support—particularly sexological and psycho-emotional care.  

Factors influencing quality of life

Multivariate analysis identified several predictive factors for poor QoL evolution:

• Presence of bone metastases
• Cardiovascular comorbidities
• Low baseline QoL
• Age > 75 years
• Lack of social support or psychological care

These findings support a personalized approach, including systematic QoL assessment before treatment to identify patients at risk of deterioration.  

Can we better support hormone therapy?

The PRISME study makes a major contribution to understanding the real-life impact of GnRH agonists on patients’ daily well-being. Although the average overall QoL remains stable, a significant proportion of patients experience detrimental physical and emotional effects. These results call for better anticipation of side effects through:

• Structured QoL monitoring programs
• Multidisciplinary support (urology, psychology, supportive care)
• Early targeted interventions for vulnerable subgroups

The goal is clear: to maintain an acceptable quality of life throughout therapy—not merely to achieve biological disease control. Personalizing hormone therapy based on QoL profiles could become a new standard in urologic oncology. 

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