Hormonal therapy for patients with advanced adenocarcinoma of the prostate: is there a role for discontinuing treatment after prolonged androgen suppression?

Pedraza, Roberto; Kwart, Arnold M.

doi:10.1016/s0090-4295(02)02441-x

Cited by 17 publications

(8 citation statements)

References 8 publications

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“…However, old age and maximal androgen blockage reduced testosterone recovery. Pedraza and Kwart [14] reported on four elderly patients (mean age, 70 years old) who received long-term LHRHa treatment. All four patients remained at the castration level 3 years after ADT cessation with undetectable PSA levels.…”

Section: Discussionmentioning

confidence: 99%

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

Nam¹,

Choi²,

Ryu³

et al. 2018

European Urology Supplements

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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.

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Section: Discussionmentioning

confidence: 99%

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

Nam¹,

Choi²,

Ryu³

et al. 2018

European Urology Supplements

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“…After ASCT, the patient continued to receive hormonal therapy, which has previously been associated with improvement in disease-free survival also in patients with advanced prostate cancer (20). It cannot be unequivocally determined, whether the undetectable levels of PSA and halted disease progression during the first years after transplant observed in our patient resulted from the hormonal therapy or reflected a T-cell-mediated GvT effect or a combination of both.…”

Section: Discussionmentioning

confidence: 73%

Increased Frequency and Responsiveness of PSA-Specific T Cells After Allogeneic Hematopoetic Stem-Cell Transplantation

Uhlin

Okas²,

Karlsson³

et al. 2009

Transplantation

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Lymphocytes from the peripheral blood of the recipient, but not from donor or other tested control individuals, exhibited ex vivo cytotoxic activity against target cells pulsed with the relevant synthetic peptides and efficiently expanded in vitro following specific restimulations. Thus, the results of this study indicate that female to male ASCT can increase the frequency and enhance specific-responsiveness of PSA-specific T cells in transplant recipients.

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“…Die erste abgeschlossene Phase-III-Studie zur primären IAD vs. kontinuierlichen MAB (Goserelin + Bicalutamid) schloss 335 Patienten mit einem unbehandelten Pk (Stadium D 1 und D 2) ein. Wenn nach einer einleitenden MAB ein PSA < 4 ng / ml erreicht wurde, dauerte es unter der IAD median 16 …”

Section: Medikamentöse Versus Chirurgische Kastrationunclassified

“…Die individuelle Variationsbreite ist groß. Bei über 70-Jährigen mit einem fortgeschrittenen Pk stieg nach > 94-monatiger LHRH-A Anwendung der Testosteronspiegel nicht mehr über 50 ng / dl [16]. Es zeigt sich eine Evidenzstärke II b, dass Behandlungsdauer und Alter des Patienten den Testosteronanstieg nach Absetzen des LHRH-A beeinflussen.…”

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LHRH-Analoga zur Androgendeprivation beim Prostatakarzinom. Eine Evidenzlevelanalyse

Pfitzenmaier¹,

Altwein²

2009

Aktuel Urol

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In this review the current indications and the options for LHRH analogues are elucidated. For this purpose, a literature search in PubMed and the Cochrane-Database was performed. In addition, the EAU and AUA guidelines as well as actual meeting abstracts up to 2008 were taken into account. Since the first prospective study in 1991 showed the same effectivity for LHRH analogues and orchiectomy in metastasised prostate cancer patients, the use of LHRH analogues increased thereafter. Testosterone levels do not need to be checked regularly, but rather only when PSA rises again under treatment. After cessation of LHRH analogue treatment the time to testosterone level recovery is longer when the treatment time was longer. One must especially recognise the risks of diabetes and osteoporosis after more than 3 years of LHRH analogue treatment. In the case of neoadjuvant and adjuvant LHRH analogue treatment, several points have to be taken into consideration: LHRH analogues before radical prostatectomy lead to a lower positive margin rate and lower rate of lymph node metastasis, but tumour-specific survival is not improved. In contrast, neoadjuvant LHRH analogue treatment before radiation therapy leads to better tumour-specific and overall survival. An increased cardiovascular toxicity was not observed. Intermittent androgen ablation has been proved to be equivalent with a reduction of side effects. Hormonal salvage therapy should be initiated when the PSA doubling time is short or the PSA velocity is > 2 ng / mL / year. The benefit of early initiation (PSA < 10 ng / mL, PSA doubling time < 12 months) is that it can prolong the metastasis-free survival time.

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Hormonal therapy for patients with advanced adenocarcinoma of the prostate: is there a role for discontinuing treatment after prolonged androgen suppression?

Cited by 17 publications

References 8 publications

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

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

Increased Frequency and Responsiveness of PSA-Specific T Cells After Allogeneic Hematopoetic Stem-Cell Transplantation

LHRH-Analoga zur Androgendeprivation beim Prostatakarzinom. Eine Evidenzlevelanalyse

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