Open Access

ARTICLE

Decreased testosterone recovery after androgen deprivation therapy for prostate cancer

Margaret E. Long¹, Andrew M. Vitale², Sarah L. Mott³, Chad Tracy², Rohan Garje³, Yousef Zakharia³, James A. Brown²

1 Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
2 Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
3 Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Address correspondence to Dr. James A. Brown, UIHC, Department of Urology, 200 Hawkins Drive, Iowa City, IA 52242-1089 USA

Canadian Journal of Urology 2021, 28(4), 10738-10742.

Abstract

Introduction: Androgen deprivation therapy (ADT) is often used in the treatment of prostate cancer. Specific factors affecting testosterone recovery after cessation of ADT have not been well-characterized in existing literature.
Materials and methods: We retrospectively reviewed patients at our institution who received ADT between 1999 and 2018. Patients with at least one course of ADT and subsequent testosterone level within 12 months of cessation of ADT were included. Patients received at least one of the following four agents: leuprolide, goserelin, triptorelin, and degarelix. Cox regression models were utilized to estimate the effect of patient and treatment characteristics on time to testosterone recovery (≥ 240 ng/dL) after ADT cessation. Patients without testosterone recovery were censored at last testosterone evaluation. To account for the possible dependency between multiple ADT courses within a patient, we used a robust sandwich variance estimate.
Results: Seventy-six patients were included. Mean age was 64 +/- 8 years. Median duration of ADT was 15 months, with a median time to recovery of 19 months. On univariable analysis, age and duration of ADT were significant; a trend towards significance was noted for hypertension, diabetes, peripheral vascular disease, goserelin, and bicalutamide. Patient age, duration of ADT, and treatment with the agent goserelin were significantly associated with prolonged hypogonadism on multivariable analysis (p < 0.01).
Conclusions: Increasing age and duration of ADT therapy are associated with decreased likelihood to recover normal testosterone levels after cessation of therapy. The use of the ADT agent goserelin was also associated with decreased testosterone recovery for unclear reasons.

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