Duration Of Testosterone Suppression And The Risk Of Death From Prostate Cancer In Men Treated Using Radiation And 6 Months Of Hormone Therapy (p NA)

Main Category: Prostate / Prostate Cancer
Also Included In: Radiology / Nuclear Medicine;  Endocrinology;  Clinical Trials / Drug Trials
Article Date: 11 Nov 2007 - 0:00 PDT

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UroToday.com- Dr. Anthony D'Amico and colleagues report in Cancer, that the duration of testosterone (androgen) suppression (AS) following androgen deprivation therapy (ADT) in combination with radiotherapy is associated with the risk of prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM).

The study was partially based upon the knowledge that older men have a longer time to return serum testosterone levels to noncastrate levels as compared to younger men. They hypothesized that in men with one high-risk feature who receive ADT for 6 months the outcome would be partially related to the duration of AS following the ADT. The study cohort consisted of 220 men who received 6 months ADT and radiotherapy for at least one high-risk feature. A high-risk feature was defined as a Gleason score >7, a PSA level >10ng/ml, or clinical stage >T2b disease. An anti-androgen was administered for 85 days after the second 3-month LHRH agonist depot injection. Total serum testosterone was measured at baseline and within 1 week to follow-up.

Median follow-up was 6.1 years and no patient was lost to follow-up. Regarding AS, after 6, 12, 18, 24, and 36 months, 16%, 38%, 55%, 68%, and 81% of men respectively had a return of testosterone to the baseline level. The median duration of AS was 15 months. Among the 220 patients 19 (9%) did not experience a return to the baseline testosterone level after a median follow-up of 7.5 years. An increasing baseline testosterone level was not associated with the duration of AS but advancing age at the completion of ADT was associated with the duration of AS. The median duration of AS was 12, 14, and 16 months for men ages <60 years, 61-64 years and >65 years, respectively. A total of 12 men (5.5%) died due to CaP. Significantly higher estimates of PCSM were seen in men with Gleason Score 8-10 tumors who had a duration of AS <2 years as compared with men who had a duration of AS >2 years. The age adjusted estimates of overall survival and the age adjusted ACM were significantly higher in men who had a duration of AS <2 years compared with all others. These estimates were 19% and 7% at 5 years.

The authors conclude that this data supports the use of the duration of AS after 6 months ADT as a method to identify men who have CAP with Gleason score 8-10 tumors who may achieve the CaP specific survival benefit associated with longer term use of ADT.

D'Amico AV, Renshaw AA, Loffredo B, Chen MH

Cancer. ePub: September 7, 2007
Doi: 10.1002/cncr.22972

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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