Testosterone [T] Recovery after Cessation of ADT.

[pjoshea13]

New Memorial Sloan Kettering study [1].

"307 men with a mean age of 65 ± 8 years were included. Mean duration of ADT was 17 ± 25 months, and median follow-up was 31 ± 35 months. Mean TT {total T} values were 379 ng/dL at baseline and 321 ng/dL at >24 months. At 24 months after cessation of ADT, 8% of men remained at castrate level, 76% returned to TT >300 ng/dL, and 51% had returned BTB. Lower baseline T levels (TT < 400 ng/dL) and ADT duration >6 months were associated with a lower likelihood of recovery to normal TT at 24 months. Age >65 years and receiving ADT for >6 months were significantly associated with a slower T recovery."

They seem to be using a cutoff for hypogonadism of 300 ng/dL, rather than the more common level of 350 ng/dL used these days.

Mean total T was 379 ng/dL at baseline - not a lot higher than 350 ng/dL. & 321 ng/dL at >24 months, i.e. below 350 ng/dL.

"T recovery after ADT is not certain and may take longer than expected. Considering the range of side effects of low T, we believe that these findings must be discussed with patients before initiating such therapies."

Of course, T recovery could be speeded up with T replacement.

As Dr. Freedland has stated, the off-phase of IADT is largely a continuation of castration for many men. Not an immediate return to a good QoL.

-Patrick

ncbi.nlm.nih.gov/pubmed/310...

J Sex Med. 2019 May 9. pii: S1743-6095(19)30735-0. doi: 10.1016/j.jsxm.2019.03.273. [Epub ahead of print]

Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer.

Nascimento B1, Miranda EP2, Jenkins LC3, Benfante N4, Schofield EA5, Mulhall JP6.

Author information

1

Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA; Sexual Medicine Service, Division of Urology, Hospital das Clinicas - University of Sao Paulo Medical School, Sao Paulo, Brazil.

2

Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA; Division of Urology, Federal University of Ceara, Ceara, Brazil.

3

Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA; Urology Service, Ohio State University, Columbus, OH, USA.

4

Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA.

5

Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, NY, NY USA.

6

Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NY, NY USA. Electronic address: [e-mail].

Abstract

INTRODUCTION:

Androgen deprivation therapy (ADT) is frequently used in the treatment of prostate cancer worldwide. Variable testosterone (T) recovery profiles after ADT cessation have been cited.

AIM:

To evaluate T recovery after cessation of ADT.

METHODS:

We reviewed our institutional prospectively maintained database of patients with prostate cancer who received ADT. Serum early morning total T (TT) levels, collected at baseline and periodically after ADT cessation, were analyzed. Patient age, baseline T level, duration of ADT, and presence of diabetes and sleep apnea were selected as potential predictors of T recovery. 3 metrics of T recovery after 24 months of ADT cessation were analyzed: return to non-castrate level (TT > 50 ng/dL), return to normal (T > 300 ng/dL), and return back to baseline level (BTB). Multivariable time-to-event analysis (Cox proportional hazards), χ2 test, logistic regression model, and Kaplan-Meier curve were performed to define impact of the above predictors on time and chance of T recovery.

MAIN OUTCOME MEASURES:

Time and chance of T recovery to non-castrate level (TT > 50 ng/dL), return to normal (T > 300 ng/dL), and return BTB.

RESULTS:

307 men with a mean age of 65 ± 8 years were included. Mean duration of ADT was 17 ± 25 months, and median follow-up was 31 ± 35 months. Mean TT values were 379 ng/dL at baseline and 321 ng/dL at >24 months. At 24 months after cessation of ADT, 8% of men remained at castrate level, 76% returned to TT >300 ng/dL, and 51% had returned BTB. Lower baseline T levels (TT < 400 ng/dL) and ADT duration >6 months were associated with a lower likelihood of recovery to normal TT at 24 months. Age >65 years and receiving ADT for >6 months were significantly associated with a slower T recovery.

CLINICAL IMPLICATIONS:

T recovery after ADT is not certain and may take longer than expected. Considering the range of side effects of low T, we believe that these findings must be discussed with patients before initiating such therapies.

STRENGTHS & LIMITATIONS:

Our strengths consisted of a relatively large database, long follow-up, and clinically meaningful endpoints. Limitations included the retrospective design of the study.

CONCLUSION:

T recovery rates after ADT cessation vary according to patient age, ADT duration, and baseline T levels. Approximately one-quarter of patients failed to normalize their TT level, and one-tenth of men remained at castrate levels 24 months after ADT cessation. Nascimento B, Miranda EP, Jenkins LC, et al. Testosterone Recovery Profiles After Cessation of Androgen Deprivation Therapy for Prostate Cancer. J Sex Med 2019;XX:XXX-XXX.

Copyright © 2019. Published by Elsevier Inc.

KEYWORDS:

Androgen Deprivation Therapy; Castration; Prostate Cancer; Testosterone Deficiency; Testosterone Recovery

PMID: 31080102 DOI: 10.1016/j.jsxm.2019.03.273

[teamkv]

So would most MO even provide T replacement after treatment and the 18-24months of ADT?

[NPfisherman in reply to teamkv]

I think most MO's see T as "fuel" for prostate cancer....that attitude may be changing over time......I have a buddy who is on ADT vacation and he is in no rush to push T levels up...if I ever get an ADT vacation, my philosophy will be the same...let it rise slowly and watch the PSA....Nalakrats used some sort of grass derivative capsule to raise his T to normal--you can message him if interested teamkv... Have a great week...

Fish

[FCoffey]

I fall within that age group and treatment regime, but nothing else comes close. Before ADT my serum T was between 850 and 1060. The MO didn't believe it and ordered repeat tests, which confirmed the values.

ADT worked all too well, dropping T to low 20s, but instead of treatment it was the start of my death. I couldn't stand it.

When I finally refused any more, the MO explained that at my age and after so long on ADT, it might take 6, 12, or 24 months, or it might never return.

One month later it was above 350, two months later it crossed 750 before leveling off close to where it had been before.

As you point out, a mean of 379 is pretty low. I'd like to see the distribution. Men who go in with low levels are apt to stay that way, but I wonder if other men with high levels recover more or faster.

[teamkv in reply to FCoffey]

How long were you on ADT?

[FCoffey in reply to teamkv]

17 months before I put a stop to it.

[Joe_Maz in reply to FCoffey]

I was on Eligard for 12 months, I also stop it ( Jan 2019 Psa <0.05 TT=24) (Apr 2019 Psa<0.05 TT=66). Also started Testosterone 50mg Androgen gel Apr 19 every other day. I do feel an lot better without depression. My next blood test will be in July with an new set of numbers. Also had 38 Radiation treatments back in Jan 2018. Still have prostate.