Testosterone recovery profiles after cessation of androgen deprivation therapy (ADT)
Mulhall, J1; Nascimento , B1; Bernie, H1; Schofield , E1; Miranda, E1
1: Memorial Sloan Kettering Cancer Center
Objective: To evaluate Testosterone (T) recovery after cessation of Androgen Deprivation Therapy (ADT) in Prostate Cancer (PCa) patients
Material and Methods: We reviewed our prospectively maintained database for PCa patients who received ADT therapy at our institution. Serum early morning total T (TT) levels were measured at baseline and periodically after ADT cessation. Multivariable time-to-event analysis (Cox proportional hazards) was performed to determine predictors of TT recovery after ADT cessation and included the following variables: patient age, baseline T level, and duration of ADT.
Result(s): 1641 men with a mean age of 66 (43-94) years were included. Primary treatment for PCa was RP in 36%, while the remainder had either RT or primary ADT. The majority received a GnRH agonist as mainstay for ADT. Mean duration of ADT was 28.8 ± 39 months [0.5 to 324]. Distribution of ADT exposure was: <6 months (m) 33%, 6-12m 19%, 12-24m 16%, >24m 33%. Median follow-up was 47.5 ± 45 months. Mean TT values were: baseline 358 ng/dl, 6-12m post ADT cessation 96 ng/dl, 12-18 174 ng/dl, 18-24m 228 ng/dl, >24m 273 ng/dl. At last follow-up: 77% men had TT level above castrate level, 45% had TT >300ng/dl and 39% returned to pre-treatment TT level. Age over 65 years, ADT duration of 6 months or greater, and baseline T of less than 400 ng/dl were all significantly associated with a slower recovery time. Multivariable analysis data are presented in the Table.
Conclusion: Approximately one third of patients undergoing ADT for prostate cancer at our center had return of TT level back to pre-treatment level with 23% maintaining castrate TT levels at 24 months after ADT cessation
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