Testosterone [T] & ADT prognosis.

[pjoshea13]

New Japanese study below.

"This study demonstrated that neoadjuvant ADT showed potential deleterious effects in ... patients with lower serum testosterone levels, while a possible improved prognosis in patients with high serum testosterone levels treated with neoadjuvant ADT was suggested, warranting further exploration."

One more study implicating low T at diagnosis with a poorer outcome.

-Patrick

ncbi.nlm.nih.gov/pubmed/301...

Prostate Int. 2018 Sep;6(3):104-109. doi: 10.1016/j.prnil.2017.10.002. Epub 2017 Nov 21.

Neoadjuvant androgen-deprivation therapy with radical prostatectomy for prostate cancer in association with age and serum testosterone.

Akitake N1, Shiota M1, Obata H1, Takeuchi A1, Kashiwagi E1, Imada K1, Kiyoshima K1, Inokuchi J1, Tatsugami K1, Eto M1.

Author information

1

Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Abstract

BACKGROUND:

We aimed to identify the candidate prostate cancer patients suitable for neoadjuvant androgen-deprivation therapy (ADT) with radical prostatectomy (RP).

MATERIALS AND METHODS:

This study included 711 Japanese patients with clinically localized prostate cancer who were treated with RP between 2000 and 2013. Patients were treated with or without neoadjuvant ADT before RP. The prognostic significance of neoadjuvant ADT on biochemical recurrence (BCR) was analyzed according to various clinicopathological characteristics.

RESULTS:

BCR occurred in 186 (26.2%) of 711 patients. The group treated with neoadjuvant ADT showed higher levels of prostate-specific antigen at diagnosis and advanced clinical T-stage, but suppressed pathological T-stage. Neoadjuvant ADT was not associated with the risk of BCR. In subgroup analysis, neoadjuvant ADT was significantly associated with increased BCR in patients aged >65 years [hazard ratio (95% confidence interval), 2.04 (1.13-3.43), P = 0.020]. Among the 53 patients with available serum testosterone levels, neoadjuvant ADT was associated with the risk of BCR according to serum testosterone levels.

CONCLUSION:

This study demonstrated that neoadjuvant ADT showed potential deleterious effects in older patients and patients with lower serum testosterone levels, while a possible improved prognosis in patients with high serum testosterone levels treated with neoadjuvant ADT was suggested, warranting further exploration.

KEYWORDS:

Age; Neoadjuvant androgen-deprivation therapy; Prostate cancer; Radical prostatectomy; Testosterone

PMID: 30140660 PMCID: PMC6104286 DOI: 10.1016/j.prnil.2017.10.002

[arete1105]

Can someone interpret this - what ADT drugs were used and what were the levels of T?

So ADT improved with higher T and was deleterious with lower levels of T?

[pjoshea13 in reply to arete1105]

My take, based on earlier studies is that men in the upper range of hypogonadal - i.e. below 350 ng/dL but not castrate - present with more advanced cancer.

Will seem counterintuitive to some that men with already low T do not have a treatment advantage. However, an old study at Johns Hopkins found that T levels had increased 12 months after prostatectomy. Seems that the cancer is able to lower T production.

-Patrick

[henukit]

Good stuff, Patrick. So the evidence is accumulating that testosterone role in the PCa is not that simple. The study above goes along with the idea that low testosterone and higher estradiol levels maybe one of the strongest initiating factors behind it.

I'm going to buy and read this book: The New Testosterone Treatment: How You and Your Doctor Can Fight Breast Cancer, Prostate Cancer, and Alzheimer's by Edward Friedman. (amazon.com/New-Testosterone.... Looks like author has done a lot of research in the field. If this hypothesis holds true the PCa onset could be easily delayed/stopped by restoring healthy hormonal balances. Too bad I didn't know all this information before. I suspect my T was low prior to Dx. But let's see what we can do now.