Testosterone Responders to Continuous Androgen Deprivation Therapy Show Considerable Variations in Testosterone Levels on Followup: Implications for Clinical Practice

No AccessJournal of UrologyAdult Urology1 Jan 2018Testosterone Responders to Continuous Androgen Deprivation Therapy Show Considerable Variations in Testosterone Levels on Followup: Implications for Clinical Practice Rashid K. Sayyid, Abdallah K. Sayyid, Zachary Klaassen, Kamel Fadaak, Hanan Goldberg, Thenappan Chandrasekar, Ardalanejaz Ahmad, Ricardo Leao, Nathan Perlis, Karen Chadwick, Robert J. Hamilton, Girish S. Kulkarni, Antonio Finelli, Alexandre R. Zlotta, and Neil E. Fleshner Rashid K. SayyidRashid K. Sayyid Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia More articles by this author , Abdallah K. SayyidAbdallah K. Sayyid Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Zachary KlaassenZachary Klaassen Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia More articles by this author , Kamel FadaakKamel Fadaak Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Hanan GoldbergHanan Goldberg Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Thenappan ChandrasekarThenappan Chandrasekar Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Ardalanejaz AhmadArdalanejaz Ahmad Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Ricardo LeaoRicardo Leao Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Nathan PerlisNathan Perlis Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Karen ChadwickKaren Chadwick Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Robert J. HamiltonRobert J. Hamilton Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Girish S. KulkarniGirish S. Kulkarni Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Antonio FinelliAntonio Finelli Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author , Alexandre R. ZlottaAlexandre R. Zlotta Department of Urology, Mt. Sinai Hospital, Toronto, Ontario, Canada More articles by this author , and Neil E. FleshnerNeil E. Fleshner Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.07.078AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined whether men on continuous androgen deprivation therapy who achieve testosterone less than 0.7 nmol/l demonstrate subsequent testosterone elevations during followup and whether such events predict worse oncologic outcomes. Materials and Methods: We evaluated a random, retrospective sample of 514 patients with prostate cancer treated with continuous androgen deprivation therapy in whom serum testosterone was less than 0.7 nmol/l at University Health Network between 2007 and 2016. Patients were followed from the date of the first testosterone measurement of less than 0.7 nmol/l to progression to castrate resistance, death or study period end. Study outcomes were the development of testosterone elevations greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, and progression to a castrate resistant state. Survival curves were constructed to determine the rate of testosterone elevations. Multivariate Cox regression analysis was done to assess whether elevations predicted progression to castrate resistance. Results: Median patient age was 74 years and median followup was 20.3 months. Within 5 years of followup 82%, 45% and 18% of patients had subsequent testosterone levels greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, respectively. In 96% to 100% of these patients levels less than 0.7 nmol/l were subsequently reestablished within 5 years. No patient baseline characteristic was associated with elevations and elevations were not a significant predictor of progression to a castrate resistant state. Conclusions: Men on continuous androgen deprivation therapy in whom initial testosterone is less than 0.7 nmol/l frequently show subsequent elevations in serum testosterone. Such a development should not trigger an immediate response from physicians as these events are prognostically insignificant with regard to oncologic outcomes. Levels are eventually reestablished at less than 0.7 nmol/l. References 1 : Role of luteinising hormone releasing hormone (LHRH) agonist in the management of prostate cancer. Eur Urol2005; 4: 4. Google Scholar 2 : Studies on prostatic cancer: I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate—1941. J Urol2002; 168: 9. Link, Google Scholar 3 : EAU guidelines on prostate cancer. 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Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTremblay S, Summers-Trasiewicz L, Pouliot F, Crook J, Ding K, Klotz L and Toren P (2021) Interpreting Testosterone and Concomitant Prostate Specific Antigen Values during Androgen Deprivation Therapy for Recurrent Prostate CancerJournal of Urology, VOL. 206, NO. 5, (1166-1176), Online publication date: 1-Nov-2021.Saad F, Fleshner N, Pickles T, Niazi T, Lukka H, Pouliot F, Martins I and Klotz L (2020) Testosterone Breakthrough Rates during Androgen Deprivation Therapy for Castration Sensitive Prostate CancerJournal of Urology, VOL. 204, NO. 3, (416-426), Online publication date: 1-Sep-2020.Taneja S (2017) Re: Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate CancerJournal of Urology, VOL. 199, NO. 1, (26-28), Online publication date: 1-Jan-2018. Volume 199Issue 1January 2018Page: 251-256Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsandrogen antagonistsprostatic neoplasmstestosteronecastrationprognosisMetricsAuthor Information Rashid K. Sayyid Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia More articles by this author Abdallah K. Sayyid Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Zachary Klaassen Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia More articles by this author Kamel Fadaak Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Hanan Goldberg Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Thenappan Chandrasekar Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Ardalanejaz Ahmad Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Ricardo Leao Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Nathan Perlis Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Karen Chadwick Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Robert J. Hamilton Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Girish S. Kulkarni Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Antonio Finelli Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Alexandre R. Zlotta Department of Urology, Mt. Sinai Hospital, Toronto, Ontario, Canada More articles by this author Neil E. Fleshner Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada More articles by this author Expand All Advertisement PDF downloadLoading ...