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Prospective Study of Testosterone Suppression and Recovery after 6 months of Androgen Deprivation Therapy and Radiation for Clinically Localized Prostate Cancer
Adam R Metwalli1, Aref N. Dajani2, Robert Brookland1, Heather Thomas3, Ronald F. Tutrone1
1Chesapeake Urology Associates, Baltimore, MD;2Independent Statistical Consultant, Greenbelt, MD;3Chesapeake Urology Research Associates, Baltimore, MD
Introduction: Tesosterone suppression and recovery is not uniform among men who have received LHRH Agonist therapy for the treatment of prostate cancer. We prospectively measured testosterone levels before, during, and for 12 months after cessation of LHRH therapy in men undergoing radiation for clinically localized prostate cancer.
Materials & Methods: From 2001 to 2003, 29 patients with T1c-T3 prostate cancer undergoing definitive radiation combined with 6 months of Eligard 22.5 mg were enrolled in a 12 month open label study of Testosterone suppression and recovery. Patients were followed at Months 1, 3, 7, 9 and 12 with serum Testosterone and PSA.
Results: Median time to Castrate testosterone as defined by Testosterone less than 20ng/dL was 3 months with a mean of 2.68 months and 25 of 29 achieved at least one value at that level. Only 13 (44.8%) patients had sustained suppression of testosterone less than 20ng/dL for the entire 6 month intended duration of therapy. Only 9 of the 29 subjects had returned to within 90% of their baseline testosterone level by 12 months. Median time to recovery of 90% of baseline testosterone was 15 months with a mean of 13.8 months.
Conclusions: Testosterone suppression with standard LHRH agonist therapy may require as long as 3 months to achieve testosterone levels equivalent to surgical castration. Less than half have sustained suppression of testosterone for the full duration of therapy. ADT also Results in prolonged testosterone suppression that may persist more than a year after therapy has been discontinued.
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