Serum Testosterone Recovery After Cessation Of Long-Term Luteinizing Hormone-Releasing Hormone Agonist In Patients With Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Endocrinology
Article Date: 19 Apr 2008 - 0:00 PDT

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UroToday.com - A longer duration of androgen deprivation therapy (ADT) results in a decreased likelihood of the recovery of testosterone. Although the pituitary gland remains functional and luteinizing hormone continues to be expressed, the Leydig cells in the testes can have irreversible dysfunction. In the online version of Urology, Dr. Bong and associates report on the testosterone recovery of a small group of men who underwent long-term ADT.

If men are treated with up to 12 months of ADT, 73-100% will regain normal testosterone levels within 6 months of stopping treatment. This number drops to 0-18% in patients who received 3 years of ADT according to literature cited by the authors. In this study 15 patients who had received at least 48 months of ADT were studied for testosterone and PSA levels. All patients had failed radical prostatectomy or radiotherapy and had a rising PSA. However, none had metastatic disease. All men had undetectable PSA levels for the duration of ADT. Patients had not been receiving ADT for 18 months, primarily due to side effects. A testosterone level <50ng/dL was considered castrate, 50-240ng/dL subnormal and >240ng/dL normal. A PSA recurrence was defined as a value of 0.4ng/ml or greater.

Average patient age at the start of ADT was 71 years and the median duration of LHRH agonist therapy was 73 months. At the cessation of therapy after a mean follow-up of 31 months, 8 men (53%) had testosterone levels that remained castrate, 6 (40%) had subnormal levels and 1 (7%) had a normal level. The mean testosterone level for the non-castrated patients was less than normal at 174ng/dL. Of the 7 patients with a non-castrate testosterone level, 5 experienced a PSA increase. The PSA velocity in these men was low at 0.37ng/ml/year. All patients with an intact prostate who had a recovery of testosterone to above castrate levels had a PSA increase. Regarding age, 78% of men who started ADT after age 70 years remained castrate compared with 17% of those who started before 70 years.

Thus, among these men with non-metastatic CaP treated with long-term ADT almost half experienced a recovery of the testosterone level to above castrate levels by 2.5 years after stopping therapy.

Bong GW, Clarke HS Jr, Hancock WC, Keane TE

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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