Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Dec 28, 2015; 7(12): 494-500
Published online Dec 28, 2015. doi: 10.4329/wjr.v7.i12.494
Recovery of serum testosterone following neoadjuvant and adjuvant androgen deprivation therapy in men treated with prostate brachytherapy
Hideyasu Tsumura, Takefumi Satoh, Hiromichi Ishiyama, Shuhei Hirano, Ken-ichi Tabata, Shinji Kurosaka, Kazumasa Matsumoto, Tetsuo Fujita, Masashi Kitano, Shiro Baba, Kazushige Hayakawa, Masatsugu Iwamura
Hideyasu Tsumura, Takefumi Satoh, Shuhei Hirano, Ken-ichi Tabata, Shinji Kurosaka, Kazumasa Matsumoto, Tetsuo Fujita, Shiro Baba, Masatsugu Iwamura, Department of Urology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
Hiromichi Ishiyama, Masashi Kitano, Kazushige Hayakawa, Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara 252-0374, Japan
Author contributions: Tsumura H performed the majority of the work including collecting, analyzing, and interpreting the data and writing the report; Ishiyama H, Hirano S, Kurosaka S and Kitano M contributed to collecting the data; Tabata K, Matsumoto K and Fujita T were participated in analyzing and interpreting the data; Satoh T, Baba S, Hayakawa K and Iwamura M designed and coordinated the study.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Kitasato University School of Medicine and Kitasato University Hospital (B14-21).
Informed consent statement: This retrospective study was performed under IRB approval, all data is de-identified for statistical analysis. Therefore, we think that a waiver of informed consent may be justifiable under this situation.
Conflict-of-interest statement: Dr. Tsumura received honoraria for lecture fees from Nihon Medi-Physics Co, Ltd. Astellas Pharma Inc, and Takeda Pharmaceutical Co, Ltd. Drs Satoh, Ishiyama and Hayakawa received honoraria for lecture fees from Medicon Co, Ltd, and Nihon Medi-Physics Co, Ltd.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hideyasu Tsumura, MD, Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara 252-0374, Japan. tsumura@med.kitasato-u.ac.jp
Telephone: +81-42-7789091 Fax: +81-42-7789374
Received: May 8, 2015
Peer-review started: May 9, 2015
First decision: July 27, 2015
Revised: August 13, 2015
Accepted: October 12, 2015
Article in press: October 12, 2015
Published online: December 28, 2015
Processing time: 233 Days and 16.8 Hours
Abstract

AIM: To investigate the time course of testosterone (T) recovery after cessation of androgen deprivation therapy (ADT) in patients treated with brachytherapy.

METHODS: One-hundred and seventy-four patients treated between June 1999 and February 2009 were studied. Patients were divided into a short-term usage group (≤ 12 mo, n = 91) and a long-term usage group (≥ 36 mo, n = 83) according to the duration of gonadotropin-releasing hormone agonist therapy. Median follow-up was 29 mo in the short-term group and was 60 mo in the long-term group.

RESULTS: Cumulative incidence rates of T recovery to normal and supracastrate levels at 24 mo after cessation were 28.8% and 74.6%, respectively, in the long-term usage group, whereas these values were 96.4% and 98.8% in the short-term usage group. T recovery to normal and supracastrate levels occurred significantly more rapidly in the short-term than in the long-term usage group (P < 0.001 and P < 0.001, respectively). Five years after cessation, 22.6% of patients maintained a castrate T level in the long-term usage group. On multivariate analysis, lower T levels (< 10 ng/dL) at cessation of ADT was significantly associated with prolonged T recovery to supracastrate levels in the long-term usage group (P = 0.002).

CONCLUSION: Lower T levels at cessation of ADT were associated with prolonged T recovery in the long-term usage group. Five years after cessation of long-term ADT, approximately one-fifth of patients still had castrate T levels. When determining the therapeutic effect, especially biochemical control, we should consider this delay in T recovery.

Keywords: Androgen deprivation; Gonadotropin-releasing hormone agonist; Prostate brachytherapy; Prostate cancer; Testosterone

Core tip: We evaluated the time course of testosterone recovery and the prognostic factors associated with prolonged testosterone recovery after the cessation of long-term (≥ 36 mo) androgen deprivation therapy in patients treated with brachytherapy. Five years after cessation, 22.6% of patients maintained a castrate testosterone level. We should consider this delay when determining therapeutic effects. Lower testosterone levels at cessation were significantly associated with prolonged testosterone recovery.