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Case Report

The therapeutic potential of duloxetine in prostate cancer-related fatigue

Rita De Sanctis , Alessandro Viganò 2,3
1
1 Department of Medical Oncology and Haematology, Humanitas Clinical and Research Center, IRCCS, 20089 Rozzano, Italy.
2 Department of Neurology and Psychiatry, Sapienza University, 00185 Rome, Italy.
3 Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University, 00185 Rome, Italy.
Correspondence to: Dr. Rita De Sanctis, Department of Medical Oncology and Haematology, Humanitas Clinical and Research Center, IRCCS,
20089 Rozzano, Italy. E-mail: rita.de_sanctis@cancercenter.humanitas.it

A B S T R AC T
Cancer-related fatigue (CRF) is a common polysymptomatic syndrome with no standard therapy. The authors present the case of a prostate
cancer patient in whom, during hormone therapy, disabling CRF and urinary incontinence occurred. CRF was assessed according to the
brief fatigue inventory (BFI). The patient received duloxetine, 60 mg daily, due to its impact on both CRF and incontinence. After 2 months,
the BFI score decreased (from 9 to 2) and urinary incontinence resolved. After duloxetine discontinuation, the patient maintained a low BFI
score. The authors conclude that, as a serotonin-noradrenaline reuptake inhibitor, duloxetine could be active on prostate CRF, especially
with associated urinary symptoms. Therefore, a pilot placebo-controlled trial with duloxetine to treat prostate CRF may be worthwhile.

Key words: Duloxetine; fatigue; prostate cancer

INTRODUCTION treatment for localized disease in patients unsuitable for
curative therapy or for metastatic disease. At early stages,
According to National Comprehensive Cancer Network 17% of patients undergoing HT complain about severe
[6]
guidelines, cancer-related fatigue (CRF) is a distressing, fatigue. In patients receiving both radiotherapy and HT,
persistent, subjective sense of physical, emotional and the prevalence of chronic fatigue is about 39%. [7]
cognitive tiredness due to cancer and/or its treatments,
which is not proportional to real daily living activity. CRF is a complex, polysymptomatic syndrome caused
[1]
Diagnosis of CRF depends on the administration of multi- by direct and/or indirect effects of neoplastic lesions,
dimensional scales, albeit to date the superiority of one supportive care management, comorbidities and related
scale compared to the others is not yet well defined. [2] medications, and environmental and psycho-emotional
aspects. Although CRF patho-physiology is still not
Generally, 60-90% of all cancer patients under specific completely understood, each of these above mentioned
treatment and 30-75% of cancer survivors present CRF. factors can cooperate to lead to an abnormal production
[3]
It has been reported that about 74% of prostate cancer and use of adenosine triphosphate, an increase in pro-
patients experience fatigue. This association is due, in inflammatory cytokines, adhesion molecule and acute
[4]
part, to the impact that androgen deprivation, the mainstay phase proteins. These metabolic changes are responsible
of pharmacological prostate cancer treatment, has on the for sleep-wake rhythm disorders and alterations of central
pathophysiological mechanism of CRF. [5] nervous system mediators (corticotropin-releasing hormone
increase, serotonin release and dopamine decrease). [8]
Most prostate cancer patients receive hormone therapy
(HT) during their lifetime since it is used for localized In one study, only 9% of patients with CRF were treated,
[9]
disease, as neoadjuvant/adjuvant to radiotherapy or and the rate of success was quite low. At present, no
[10]
surgery, or for biochemical relapse following radical local satisfactory standard therapy for CRF is available.
treatment. Furthermore, HT often constitutes the sole
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How to cite this article: De Sanctis R, Viganò A. The therapeutic
potential of duloxetine in prostate cancer-related fatigue. J Cancer
DOI: Metastasis Treat 2016;2:64-6.
10.4103/2394-4722.164646
Received: 21-01-2015; Accepted: 30-07-2015.

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