Testosterone recovery following prolonged adjuvant androgen ablation for prostate carcinoma.
BACKGROUND
This study was conducted to describe the rate and completeness of the recovery of testosterone production following prolonged temporary androgen ablative therapy in men with prostate carcinoma undergoing curative radiation therapy.


METHODS
Two-hundred and sixty-seven men treated with between 3 months and 3 years of adjuvant androgen ablation (AA) were followed at 6-month intervals following cessation of their androgen deprivation therapy. A comparative group of 518 men not undergoing AA were also followed.


RESULTS
Drugs used included low dose cyproterone/stilboestrol (CPA/DES) in combination (56%) and 1 month depot (18%) and 3 month depot (25%) leutinizing hormone releasing hormone agonist (LHRHa). Seventy-nine percent of men in the current study recovered normal testosterone levels (10nmol/L), and 93% recovered levels of at least 5nmol/L. In comparison, men who had never received androgen ablative therapy showed a fall of testosterone, with 17% having sub-normal levels after 3 years. Median time to testosterone recovery was 10 months. Factors associated on multivariate analysis with delayed testosterone recovery included advanced age (P = 0.008), low pre-therapy testosterone (P = 0.04), and the use of 3 month LHRHa preparations as compared with CPA/DES (P = 0.002) or 1 month LHRHa preparations (P = 0.015). The duration of drug use was not significantly associated with time to testosterone recovery.


CONCLUSIONS
Long-acting LHRHa preparations appear to have a more prolonged action than previously supposed. Most men treated for up to 2 years recover normal testosterone levels after cessation of adjuvant androgen ablation, and the limited data available in the current study on patients treated for 3 years also suggests most will recover.
Pickles
Tom
T
Vancouver Cancer Clinic, BC Cancer Agency, Canada.
Agranovich
Alex
A
Berthelet
Eric
E
Duncan
Graeme G
GG
Keyes
Mira
M
Kwan
Winkle
W
McKenzie
Michael R
MR
Morris
W James
WJ
D000230:Adenocarcinoma / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000502:physiology; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000532:radiotherapy; D018714:Radiotherapy, Adjuvant; D013737:Testis / Q000502:physiology; D013739:Testosterone / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D013739:Testosterone