Does pretreatment T level affect survival?


In a paper just published in the International Journal of Radiation Oncology Biology Physics, the authors sought to evaluate whether patients’ pretreatment serum testosterone (T) levels had any impact on survival after prostate brachytherapy.

Between October 2001 and November 2004, 619 patients underwent brachytherapy and 546 had their pretreatment serum T level measured. Pretreatment serum T levels were categorized into one of five groups as follows: below normal (n = 105), low normal (n = 246), mid normal (n = 132), high normal (n = 50), and above normal (n = 13). Median follow-up was 5.2 years. The cause of death was determined for each deceased patient.

Taira et al. report the results of this retrospective analysis as follows:

  • The 6-year biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) were 97.7, 99.8, and 89.2 percent, repectively.
  • When  patients with low or low normal T levels were compared with those with average (mid normal) or higher T levels, there was no significant difference in bPFS (97.6 vs. 98.4 percent), CSS (99.8 vs. 100 percent), or OS (88.9 vs. 90.8 percent).
  • Among patients with mid normal and higher pretreatment T levels, there was no significant difference in outcomes when comparing patients who did and did not receive androgen deprivation therapy (ADT).
  • For patients with low or low normal T levels, there was no significant difference in bPFS or CSS when comparing patients who did and did not receive ADT.
  • There was a trend toward lower OS in patients with lower baseline T levels who also received ADT (83.9 vs. 91.3 percent), but it was not statistically significant.

The authors conclude that low pretreatment testosterone levels alone did not affect disease recurrence or OS. However, it appeared as though patients with lower baseline T levels who were treated with brachytherapy and ADT had a trend toward decreased OS.

The “New” Prostate Cancer InfoLink would caution patients against reading too much into this result. This was a retrospective analysis of historic data, and only 59/546 patients (10.8 percent) had passed away from any cause within the follow-up period of the study, with only 1 patient (0.2 percent) known to have died of prostate cancer. However, it is an interesting preliminary observation that may bear additional study.

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