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The Nursing Intersection: Upregulating Quality of Life During Downregulation of the Androgen Axis

  • Authors: Victoria Sinibaldi, RN, MS, CS, CANP, CGNP; Emily A. Lemke, DNP, AGPCNP-BC, AOCNP
  • CE Released: 6/24/2020
  • Valid for credit through: 6/24/2021
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Target Audience and Goal Statement

This activity is intended for nurses and nurse practitioners.

The goal of this activity is to educate nursing professionals about current and emerging approaches with oral antiandrogen therapies in the management of locally advanced or metastatic prostate cancer to better recognize and differentiate adverse events (AEs) of therapies that target the androgen axis pathway.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • AEs associated with various therapies aimed at the androgen axis pathway in the management of prostate cancer
    • Monitoring of AEs for therapies utilized in androgen axis downregulation in prostate cancer
  • Have increased confidence regarding
    • Counseling points to empower nurses to engage in discussion with patients to optimize adherence and outcomes while on androgen axis deprivation therapies
  • Have greater competence related to
    • Mitigation of androgen axis therapy related AEs


The Annenberg Center for Health Sciences at Eisenhower requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to the Annenberg Center for Health Sciences at Eisenhower policy. The Annenberg Center for Health Sciences at Eisenhower is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest


  • Victoria Sinibaldi, RN, MS, CS, CANP, CGNP

    Adult & Geriatric Nurse Practitioner
    Research Associate in Oncology and Urology
    Faculty, School of Medicine
    Johns Hopkins University
    Baltimore, Maryland
    Participation by Ms Sinibaldi does not constitute or imply endorsement by the Johns Hopkins University or the Johns Hopkins Hospital and Health System.


    Disclosure: Victoria Sinibaldi, RN, MS, CS, CANP, CGNP, has disclosed the following relevant financial relationships:
    Served as a speaker or a member of a speakers bureau for: MCM Education

  • Emily A. Lemke, DNP, AGPCNP-BC, AOCNP

    Nurse Practitioner
    Medical College of Wisconsin Cancer Center
    Milwaukee, Wisconsin


    Disclosure: Emily A. Lemke, DNP, AGPCNP-BC, AOCNP, has disclosed no relevant financial relationships.

    The PIM planners and managers have nothing to disclose.

    Annenberg Center for the Health Sciences at Eisenhower staff involved in this activity have no relevant commercial relationships to disclose.


  • Davecia Ragoonath-Cameron, MS

    Medical Education Director, Medscape, LLC


    Disclosure: Davecia Ragoonath-Cameron, MS, has disclosed no relevant financial relationships.

  • Carol Smyth, MB

    Director, Content Development, Medscape, LLC


    Disclosure: Carol Smyth, MB, has disclosed no relevant financial relationships.

  • Yoji Yamaguchi, MA

    Associate Scientific Content Manager, Medscape, LLC


    Disclosure: Yoji Yamaguchi, MA, has disclosed no relevant financial relationships.

Content Reviewer

  • Robert Morris, PharmD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Robert Morris, PharmD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: ViiV Healthcare
    Owns stock, stock options, or bonds from: GlaxoSmithKline

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

Accreditation Statements

Jointly provided by the Annenberg Center for Health Sciences at Eisenhower and Medscape LLC in collaboration with Postgraduate Institute for Medicine

The Annenberg Center for Health Sciences at Eisenhower is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

    For Nurses

  • 1.0 contact hours may be earned for successful completion of this activity.  Designated for 0.9 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; registered nurses should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive ANCC contact hours, you must receive a minimum score of 66% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.


The Nursing Intersection: Upregulating Quality of Life During Downregulation of the Androgen Axis

Authors: Victoria Sinibaldi, RN, MS, CS, CANP, CGNP; Emily A. Lemke, DNP, AGPCNP-BC, AOCNPFaculty and Disclosures

CE Released: 6/24/2020

Valid for credit through: 6/24/2021



Question 1: What are the best treatments for hot flashes?

Answer: Venlafaxine works well. If patients have issues dealing with side effects from that, or if it doesn't work, that's usually when they can switch to gabapentin, and maybe a low dose to start. The old adage of "start low and go slow" really applies to those medications for the hot flashes.[1]

Question 2: Do hormonal changes have a psychological effect on men?

Answer: Yes, testosterone is synonymous with some aspects of male identity, and when that is taken away it can be really distressing for some men. That is why it is important to set expectations at the onset of treatment, so that the patient is not surprised by these adverse effects from medications. Being referred to therapists or psychiatrists that have a specialization in oncology can be very helpful.[2]

Question 3: Darolutamide requires fewer pills to achieve the desired dose vs apalutamide. Since they're both approved around the same time, why not use darolutamide since the number of pills daily would be less, hopefully increasing patient compliance?

Answer: It is reasonable to give the patient darolutamide to get better compliance with the patient as you have less pills to take. But the other thing you have to remember is that there are no studies that say that darolutamide is better than apalutamide; both studies show efficacy. What clinicians do is look at the side effect profiles to determine the better drug for the patient. Darolutamide does not cross the BBB and has less fatigue or could have less fatigue, less cognitive dysfunction. So again, not only by taking 2 tablets vs 4 tablets, the toxicity may be better for the patient. When looking at the side effect profiles, darolutamide has generally lower toxicities overall compared to apalutamide and enzalutamide, and patients tend to tolerate darolutamide very well.[3-5]


  1. Magee D, Singal R. Androgen deprivation therapy: indications, methods of utilization, side effects and their management. Can J Urol. 2020;27(Suppl 1): 11-16.
  2. Donovan KA, Gonzalez BD, Nelson AM, et al. Effect of androgen deprivation therapy on sexual function and bother in men with prostate cancer: a controlled comparison. Psychooncology. 2018;27:316‐324.
  3. XTANDI® (enzalutamide) [prescribing information]. Northbrook, IL: Astellas Pharma US, Inc.; Approved 2012. Revised December 2019.
  4. ERLEADA® (apalutamide) [prescribing information]. Horsham, PA: Janssen Products, LP; Approved 2018. Revised September 2019.
  5. NUBEQA™ (darolutamide) [prescribing information]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc.; Approved 2019. Revised July 2019.
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