Testosterone Responders to Continuous Androgen Deprivation Therapy Show Considerable Variations in Testosterone Levels on Followup

Implications for Clinical Practice

Rashid K. Sayyid, Abdallah K. Sayyid, Zachary W A Klaassen, Kamel Fadaak, Hanan Goldberg, Thenappan Chandrasekar, Ardalanejaz Ahmad, Ricardo Leao, Nathan Perlis, Karen Chadwick, Robert J. Hamilton, Girish S. Kulkarni, Antonio Finelli, Alexandre R. Zlotta, Neil E. Fleshner

Research output: Contribution to journalArticle

Abstract

Purpose We determined whether men on continuous androgen deprivation therapy who achieve testosterone less than 0.7 nmol/l demonstrate subsequent testosterone elevations during followup and whether such events predict worse oncologic outcomes. Materials and Methods We evaluated a random, retrospective sample of 514 patients with prostate cancer treated with continuous androgen deprivation therapy in whom serum testosterone was less than 0.7 nmol/l at University Health Network between 2007 and 2016. Patients were followed from the date of the first testosterone measurement of less than 0.7 nmol/l to progression to castrate resistance, death or study period end. Study outcomes were the development of testosterone elevations greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, and progression to a castrate resistant state. Survival curves were constructed to determine the rate of testosterone elevations. Multivariate Cox regression analysis was done to assess whether elevations predicted progression to castrate resistance. Results Median patient age was 74 years and median followup was 20.3 months. Within 5 years of followup 82%, 45% and 18% of patients had subsequent testosterone levels greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, respectively. In 96% to 100% of these patients levels less than 0.7 nmol/l were subsequently reestablished within 5 years. No patient baseline characteristic was associated with elevations and elevations were not a significant predictor of progression to a castrate resistant state. Conclusions Men on continuous androgen deprivation therapy in whom initial testosterone is less than 0.7 nmol/l frequently show subsequent elevations in serum testosterone. Such a development should not trigger an immediate response from physicians as these events are prognostically insignificant with regard to oncologic outcomes. Levels are eventually reestablished at less than 0.7 nmol/l.

Original languageEnglish (US)
Pages (from-to)251-256
Number of pages6
JournalJournal of Urology
Volume199
Issue number1
DOIs
StatePublished - Jan 1 2018

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Androgens
Testosterone
Therapeutics
Serum
Prostatic Neoplasms
Regression Analysis
Outcome Assessment (Health Care)
Physicians
Survival
Health

Keywords

  • androgen antagonists
  • castration
  • prognosis
  • prostatic neoplasms
  • testosterone

ASJC Scopus subject areas

  • Urology

Cite this

Testosterone Responders to Continuous Androgen Deprivation Therapy Show Considerable Variations in Testosterone Levels on Followup : Implications for Clinical Practice. / Sayyid, Rashid K.; Sayyid, Abdallah K.; Klaassen, Zachary W A; Fadaak, Kamel; Goldberg, Hanan; Chandrasekar, Thenappan; Ahmad, Ardalanejaz; Leao, Ricardo; Perlis, Nathan; Chadwick, Karen; Hamilton, Robert J.; Kulkarni, Girish S.; Finelli, Antonio; Zlotta, Alexandre R.; Fleshner, Neil E.

In: Journal of Urology, Vol. 199, No. 1, 01.01.2018, p. 251-256.

Research output: Contribution to journalArticle

Sayyid, RK, Sayyid, AK, Klaassen, ZWA, Fadaak, K, Goldberg, H, Chandrasekar, T, Ahmad, A, Leao, R, Perlis, N, Chadwick, K, Hamilton, RJ, Kulkarni, GS, Finelli, A, Zlotta, AR & Fleshner, NE 2018, 'Testosterone Responders to Continuous Androgen Deprivation Therapy Show Considerable Variations in Testosterone Levels on Followup: Implications for Clinical Practice', Journal of Urology, vol. 199, no. 1, pp. 251-256. https://doi.org/10.1016/j.juro.2017.07.078
Sayyid, Rashid K. ; Sayyid, Abdallah K. ; Klaassen, Zachary W A ; Fadaak, Kamel ; Goldberg, Hanan ; Chandrasekar, Thenappan ; Ahmad, Ardalanejaz ; Leao, Ricardo ; Perlis, Nathan ; Chadwick, Karen ; Hamilton, Robert J. ; Kulkarni, Girish S. ; Finelli, Antonio ; Zlotta, Alexandre R. ; Fleshner, Neil E. / Testosterone Responders to Continuous Androgen Deprivation Therapy Show Considerable Variations in Testosterone Levels on Followup : Implications for Clinical Practice. In: Journal of Urology. 2018 ; Vol. 199, No. 1. pp. 251-256.
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abstract = "Purpose We determined whether men on continuous androgen deprivation therapy who achieve testosterone less than 0.7 nmol/l demonstrate subsequent testosterone elevations during followup and whether such events predict worse oncologic outcomes. Materials and Methods We evaluated a random, retrospective sample of 514 patients with prostate cancer treated with continuous androgen deprivation therapy in whom serum testosterone was less than 0.7 nmol/l at University Health Network between 2007 and 2016. Patients were followed from the date of the first testosterone measurement of less than 0.7 nmol/l to progression to castrate resistance, death or study period end. Study outcomes were the development of testosterone elevations greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, and progression to a castrate resistant state. Survival curves were constructed to determine the rate of testosterone elevations. Multivariate Cox regression analysis was done to assess whether elevations predicted progression to castrate resistance. Results Median patient age was 74 years and median followup was 20.3 months. Within 5 years of followup 82{\%}, 45{\%} and 18{\%} of patients had subsequent testosterone levels greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, respectively. In 96{\%} to 100{\%} of these patients levels less than 0.7 nmol/l were subsequently reestablished within 5 years. No patient baseline characteristic was associated with elevations and elevations were not a significant predictor of progression to a castrate resistant state. Conclusions Men on continuous androgen deprivation therapy in whom initial testosterone is less than 0.7 nmol/l frequently show subsequent elevations in serum testosterone. Such a development should not trigger an immediate response from physicians as these events are prognostically insignificant with regard to oncologic outcomes. Levels are eventually reestablished at less than 0.7 nmol/l.",
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AU - Klaassen, Zachary W A

AU - Fadaak, Kamel

AU - Goldberg, Hanan

AU - Chandrasekar, Thenappan

AU - Ahmad, Ardalanejaz

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N2 - Purpose We determined whether men on continuous androgen deprivation therapy who achieve testosterone less than 0.7 nmol/l demonstrate subsequent testosterone elevations during followup and whether such events predict worse oncologic outcomes. Materials and Methods We evaluated a random, retrospective sample of 514 patients with prostate cancer treated with continuous androgen deprivation therapy in whom serum testosterone was less than 0.7 nmol/l at University Health Network between 2007 and 2016. Patients were followed from the date of the first testosterone measurement of less than 0.7 nmol/l to progression to castrate resistance, death or study period end. Study outcomes were the development of testosterone elevations greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, and progression to a castrate resistant state. Survival curves were constructed to determine the rate of testosterone elevations. Multivariate Cox regression analysis was done to assess whether elevations predicted progression to castrate resistance. Results Median patient age was 74 years and median followup was 20.3 months. Within 5 years of followup 82%, 45% and 18% of patients had subsequent testosterone levels greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, respectively. In 96% to 100% of these patients levels less than 0.7 nmol/l were subsequently reestablished within 5 years. No patient baseline characteristic was associated with elevations and elevations were not a significant predictor of progression to a castrate resistant state. Conclusions Men on continuous androgen deprivation therapy in whom initial testosterone is less than 0.7 nmol/l frequently show subsequent elevations in serum testosterone. Such a development should not trigger an immediate response from physicians as these events are prognostically insignificant with regard to oncologic outcomes. Levels are eventually reestablished at less than 0.7 nmol/l.

AB - Purpose We determined whether men on continuous androgen deprivation therapy who achieve testosterone less than 0.7 nmol/l demonstrate subsequent testosterone elevations during followup and whether such events predict worse oncologic outcomes. Materials and Methods We evaluated a random, retrospective sample of 514 patients with prostate cancer treated with continuous androgen deprivation therapy in whom serum testosterone was less than 0.7 nmol/l at University Health Network between 2007 and 2016. Patients were followed from the date of the first testosterone measurement of less than 0.7 nmol/l to progression to castrate resistance, death or study period end. Study outcomes were the development of testosterone elevations greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, and progression to a castrate resistant state. Survival curves were constructed to determine the rate of testosterone elevations. Multivariate Cox regression analysis was done to assess whether elevations predicted progression to castrate resistance. Results Median patient age was 74 years and median followup was 20.3 months. Within 5 years of followup 82%, 45% and 18% of patients had subsequent testosterone levels greater than 0.7, greater than 1.1 and greater than 1.7 nmol/l, respectively. In 96% to 100% of these patients levels less than 0.7 nmol/l were subsequently reestablished within 5 years. No patient baseline characteristic was associated with elevations and elevations were not a significant predictor of progression to a castrate resistant state. Conclusions Men on continuous androgen deprivation therapy in whom initial testosterone is less than 0.7 nmol/l frequently show subsequent elevations in serum testosterone. Such a development should not trigger an immediate response from physicians as these events are prognostically insignificant with regard to oncologic outcomes. Levels are eventually reestablished at less than 0.7 nmol/l.

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KW - prognosis

KW - prostatic neoplasms

KW - testosterone

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