Testosterone recovery (after 6 months of ADT).

[pjoshea13]

New study from Japan, below [1].

"... 125 patients with prostate cancer received 6 months of neoadjuvant ADT (nADT) followed by low-dose rate (LDR) brachytherapy."

"The cumulative incidence rates of TT {total testosterone} recovery to normal levels (TT ≥ 3.0 ng/mL) after 12 and 24 months cessation were 49.6% and 81.6%, respectively."

"The median interval to recover to normal TT was 15 months." {!!!}

"Approximately one-fifth of patients still had low TT levels 2 years after the cessation of 6 months nADT before LDR brachytherapy."

T recovery is slow. And for those concerned about estradiol [E2] dominance, the E2:T ratio is likely to be unfavorable for part of the recovery period. IMO

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/320...

Aging Male

, 1-7 2020 Feb 25[Online ahead of print]

Recovery of Serum Testosterone Following Neoadjuvant Androgen Deprivation Therapy in Japanese Prostate Cancer Patients Treated With Low-Dose Rate Brachytherapy

Yuki Kato 1 , Kazuyoshi Shigehara 1 , Shohei Kawaguchi 1 , Kouji Izumi 1 , Yoshifumi Kadono 1 , Atsushi Mizokami 1

Affiliations expand

PMID: 32096413 DOI: 10.1080/13685538.2020.1731450

Abstract

Objective: To investigate the time course of total testosterone (TT) recovery after cessation of androgen deprivation therapy (ADT) in Japanese patients treated with brachytherapy.Methods: In total, 125 patients with prostate cancer received 6 months of neoadjuvant ADT (nADT) followed by low-dose rate (LDR) brachytherapy. TT was measured every 3 months after cessation of nADT, and some predictive factors affecting TT recovery were analyzed.Results: The cumulative incidence rates of TT recovery to normal levels (TT ≥ 3.0 ng/mL) after 12 and 24 months cessation were 49.6% and 81.6%, respectively. The median interval to recover to normal TT was 15 months. In multivariate analysis, the use of a gonadotropin-releasing hormone (GnRH) antagonist as nADT significantly earlier improved to recovery to normal TT level (p = 0.046). Conversely, higher body mass index (BMI) and hypertension significantly prolonged TT recovery to normal (p = 0.026 and p = 0.026, respectively).Conclusions: Approximately one-fifth of patients still had low TT levels 2 years after the cessation of 6 months nADT before LDR brachytherapy. Use of a GnRH agonist, higher BMI, and hypertension were the predictive factors for slower TT recovery to normal TT levels after the cessation of nADT.

Keywords: Testosterone; androgen deprivation; gonadotropin-releasing hormone antagonist; prostate brachytherapy; prostate cancer.

[Hidden]

Hi pjoshea,

My E2/tT value climbed from 0.0034 to 0.0053 due to a rise in tT and out of proportion rise of E2. Are these good numbers? TIA

[Longterm101]

Congrats !!!!

[Ramp7]

So how long are you on the implant and time off?

Is this approach similar to what Dr. Leibowitz employs?

[MateoBeach]

My "trial-of-one" using a single injection of degarelix 120 mg supported by estradiol patches for SBRT adjuvant therapy and then following serial monthly total T levels. At 3 months after degarelix, off of the estradiol patches also, my T level was still castrate at 11. At 4 months it was becoming non-castrate at 48. So degarelix 1) May have an effective duration of action for 3 months in some individuals. And 2) exhibits must faster T recovery than LHRHa drugs.

Could you please provide good references on why the concern about estogen /estradiol for APC? The patches provide an effective and much more acceptable side effect profile for ADT. So I need to understand the basis for possible downside. Thanks!

[pjoshea13 in reply to MateoBeach]

My concern is not for pharmaceutical estradiol [E2] levels that produce castrate T.

Rather, it's when T is <350 ng/dL (but not not castrate) & E2 is >30 pg/mL. My opinion.

-Patrick