After long-term ADT … recovery of normal hormonal function?


A group of Spanish clinical researchers have reported recent data from a small study designed to address an unanswered question about the recovery of (relatively) normal hormonal function after completion of androgen deprivation therapy (ADT).

Planas et al., writing in the Scandanavian Journal of Urology, report data from a cohort of 40 patients who:

  • Were all treated with long-term ADT for locally advanced or metastatic prostate cancer
  • Had an average (mean) age of 71.5 years
  • Were treated with ADT for an average duration of 74.6 months (i.e., about 6 years) and then
  • Stopped their ADT therapy without any consequent rise in their PSA level

The men were then followed for an average of another 36.5 months (about 3 years), and their serum testosterone (T) and serum luteinizing hormone (LH) levels were determined at 6-monthly intervals after cessation of the ADT.

Here is what the research team reported:

  • At 18 months of follow-up,
    • All patients had recovered normal levels of LH.
    • 38 percent of patients still had castrate levels of serum T (< 50 ng/dl).
  • Based on a multivariate analysis
    • Only time on ADT was correlated with recovery of serum T levels > 50 ng/ml (p = 0.031)
    • Neither age nor clinical stage at start of ADT showed statistical correlation to recovery of serum T levels > 50 ng/ml
  • Average time for recovery of a serum T level of > 50 ng/ml was
    • 14.5 months in men treated with ADT for < 60 months
    • 29.3 months in men treated with ADT for > 60 months

The authors conclude that:

Age did not correlate with testosterone recovery in a group of elderly prostate cancer patients in whom ADT was stopped. Testosterone recovery after ADT cessation was significantly correlated with time under ADT treatment.

So what this tells us is that a significant percentage of men on long-term ADT are probably never going to regain anything approaching normal serum T levels on their own after stopping ADT.

We are aware of a small number of men who, after being on long-term ADT for several years, and stopping, then took testosterone replacement therapy (TRT) to regain normal serum T levels. That strategy clearly comes with a significant level of risk in men who were originally being treated with ADT for advanced or metastatic prostate cancer. Might that be an acceptable risk for some patients? Well, … probably only an individual patient could answer that question — and only with regard to himself.

 

4 Responses

  1. Coincidentally, this article appeared on Medscape on September 22. Here are the first three paragraphs:

    “Clinicians may be able to safely give testosterone therapy to hypogonadal men who have been treated for prostate cancer or are on active surveillance for the disease, according to a study of a cohort of Canadian and Australian men.

    “In other words, it appears okay to give testosterone, or T, as it is commonly called, to men with prostate cancer, say the researchers, led by Jesse Ory, MD, a urologist at the University of British Columbia in Vancouver, Canada.

    “The finding goes against a long-held belief that testosterone would be harmful, as the hormone has been linked to the growth of prostate cancer in studies that date from the 1940s. Indeed, a main treatment for prostate cancer -– androgen deprivation therapy -– aims to block testosterone.”

  2. Dear Ken:

    We had already reported on this paper by Ory et al. on September 13. See here.

  3. I have been on ADT since 2010, with two pauses.

    First pause was in 2012 and T bounced back to 20 in normal range between 8 to 38. PSA went from 0.08 to 8.0, so ADT recommenced within 6 months.

    Second pause was in 2015; T didn’t rise much, but PSA sure did, so ADT continues and with now with Cosudex after a second round of IMRT. PSA now 0.5, and decline may not be long. I’m 69.

    Testosterone is poison to me, my balls are two enemies and I may have them cut out because the Lucrin is failing to stop their T production.

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