Testosterone Recovery after Androgen Deprivation Therapy in Prostate Cancer: Building a Predictive Model

Abstract

To analyze the variability, associated actors, and the design of nomograms for individualized testosterone recovery after cessation of androgen deprivation therapy (ADT). Materials and Methods: Materials and Methods: A longitudinal study was carried out with 208 patients in the period 2003 to 2019. Castrated and normogonadic testosterone levels were defined as 0.5 and 3.5 ng/mL, respectively. The cumulative incidence curve described the recovery of testosterone. Univariate and multivariate analyzes were performed to predict testosterone recovery with candidate prognostic factors prostate-specific antigen at diagnosis, clinical stage, Gleason score from biopsy, age at cessation of ADT, duration of ADT, primary therapy and use of LHRH (luteinizing hormone-releasing hormone) agonists. Results: Results: The median follow-up duration in the study was 80 months (interquartile range, 49-99 mo). Twenty-five percent and 81% of patients did not recover the castrate and normogonadic levels, respectively. Duration of ADT and age at ADT cessation were significant predictors of testosterone recovery. We built two nomograms for testosterone recovery at 12, 24, 36, and 60 months. The castration recovery model had good calibration. The C-index was 0.677, with area under the receiver operating characteristic curve (AUC-ROC) of 0.736, 0.783, 0.782, and 0.780 at 12, 24, 36, and 60 months, respectively. The normogonadic recovery model overestimated the higher values of probability of recovery. The C index was 0.683, with AUC values of 0.812, 0.711, 0.708 and 0.693 at 12, 24, 36, and 60 months, respectively. Conclusions: Conclusions: Depending on the age of the patient and the length of treatment, clinicians may stop ADT and the castrated testosterone level will be maintained or, if the course of treatment has been short, we can estimate if it will return to normogonadic levels.

Adherence to oral hormonal therapy in advanced prostate cancer: a scoping review

“…In all, 13 observational studies assessed adherence and related measures exclusively in mCRPC patients (Table 2), 48,51,[61][62][63][64][65][66][67][68][69][70][71] while one phase III trial and two observational trials assessed adherence in advanced prostate cancer (Table 3). 14,53,72 Studies were mostly conducted in North America (n = 7) and Europe (n = 8) based on data from large national or provincial registries or hospital network databases (11), or smaller multi-or singlecenter analyses (5). Most prospective studies used questionnaire and survey tools to assess adherence (n = 4), while objective measurement of adherence rates based on pill counting was performed in two prospective trials.…”

“…2–4 These have been standard therapy for advanced prostate cancer since the 1980s. When administered in early settings, treatment can be ongoing for prolonged periods 5,6 and as such, ADT is usually administered as long-acting depot formulations which can range from a 1-month interval to up to a year. 7–13 More recently, the first orally administered LHRH antagonist relugolix 14 was approved by the FDA on 18 December 2020.…”

Androgens, brain and androgen deprivation therapy in paraphilic disorders: A narrative review

“…ADT impairs the patient's quality of life by exposing the patient to the symptoms of hypogonadism (sexual dysfunction, infertility, decreased libido, decrease in facial and body hair, decrease in muscle mass, weight gain, gynecomastia, reduced testicle size, osteoporosis, mental and emotional changes, anaemia, fatigue and hot flashes) (Borque Fernando et al, 2022).…”

“…The age of the patient and the duration of ADT are substantial in the evolution of T levels when ADT is suspended. The older people are and the longer the duration of ADT is, the longer the period of recovery (Borque Fernando et al, 2022).…”