Factors associated with testosterone recovery after androgen deprivation therapy in patients with prostate cancer

Abstract

Purpose:We investigated factors affecting testosterone recovery after androgen deprivation therapy (ADT) withdrawal in patients with prostate cancer. Materials and Methods:The medical records of patients who underwent radical prostatectomy with ADT were retrospectively reviewed. In all, 221 patients were included in the analysis. Testosterone recovery was defined as supra-castration (SC) (testosterone levels in serum >50 ng/dL) or out of hypogonadism (OH) (>300 ng/dL) after ADT withdrawal. Kaplan-Meier analyses were used to estimate testosterone recovery after ADT cessation. Cox regression analyses were used to determine the factors affecting the recovery of testosterone. Results: After ADT, 206 patients (93.2%) recovered to the SC level and 122 patients (55.2%) recovered to the OH level. Patients treated with ADT for ≤18 months recovered to OH in a mean of 6.8 months (74.6%), but patients treated with ADT for >18 months recovered in a mean of 9.7 months (27.5%). In multivariate analyses, age (hazard ratio [HR], 0.915; p<0.001), serum level of sex hormone-binding globulin (SHBG) (HR, 1.015; p=0.002), initial testosterone level (HR, 1.002; p=0.002), and ADT duration (HR, 0.915; p<0.001) were associated with recovery to the OH level after ADT withdrawal, and hypertension (HR, 0.697; p=0.029) and duration of ADT (HR, 0.979; p=0.012) were significantly associated with recovery to SC. Conclusions: In patients treated with ADT for ≤18 months, testosterone recovers to the OH level more often and faster after ADT cessation. Age, SHBG level, initial testosterone level, and ADT duration are associated with testosterone recovery.

Extraction of Treatment Information From Electronic Health Records and Evaluation of Testosterone Recovery in Patients With Prostate Cancer

“…9 Age at treatment and duration of ADT usage may influence whether patients recover their testosterone to normal levels. [10][11][12][13] However, there is also concern that patients who recover their testosterone rapidly may also progress faster. Here, we aim to provide clarity on some of these questions using our Sema4 PRO research database.…”

“…9 T-recovery after ADT is an important aspect of the clinical course that heralds a return of quality of life for patients with LPC. [10][11][12][13] The clinical attribute factors influencing T-recovery after ADT usage are being investigated in relation to different treatments for LPC. [10][11][12][13] Using unstructured (clinical notes) and structured (medication tables) data on ADT treatment information, we were able to estimate ADT treatment duration with higher accuracy than from structured tables alone.…”

“…[10][11][12][13] The clinical attribute factors influencing T-recovery after ADT usage are being investigated in relation to different treatments for LPC. [10][11][12][13] Using unstructured (clinical notes) and structured (medication tables) data on ADT treatment information, we were able to estimate ADT treatment duration with higher accuracy than from structured tables alone. Our results illustrate the power of applying machine learning methods to enhance the quality of real-world evidence in service of answering clinically relevant questions.…”

Persistent Testosterone Suppression After Cessation of Androgen Deprivation Therapy for Prostate Cancer

“…Previous studies have suggested that temporary ADT can cause persistently low T levels, long after stopping ADT [ 2 , 8 , 11 - 13 ]. Understanding factors that can cause persistent suppression of T is important so that these at-risk men can be identified and treated.…”

Management of solitary rectal ulcer syndome: Results of a french national survey

“…This is in line with findings from the TAX-3501 trial, in which addition of docetaxel to leuprolide after radical prostatectomy (either as adjuvant therapy or differed until progression) did not impact testosterone recovery 12 . An important difference between the two studies is that, in the TAX-3501 trial, ADT was pursued for only 18 months when several reports have concluded that a duration of treatment longer than 18 or 24 months negatively impacts testosterone recovery in patients treated with adjuvant ADT 17,18,21 . Since 18 months to 3 years of adjuvant ADT are now the standard of care in HRLPC patients treated with EBRT 3,4 , we felt that confirmation of those findings from TAX-3501 was needed.…”