Nejat R J, Rashid H H, Bagiella E, Katz A E, Benson M C
Squier Urological Clinic, College of Physicians and Surgeons, Department of Biostatistics, School of Public Health, Columbia University, New York, New York, USA.
J Urol. 2000 Dec;164(6):1891-4.
Patients with prostate cancer are treated with neoadjuvant, adjuvant and intermittent androgen deprivation therapy. Prostate specific antigen (PSA) is altered during androgen deprivation therapy, and as a result the prognostic significance and accuracy of PSA values measured before serum testosterone has normalized are questionable because the patient is still effectively on androgen deprivation therapy. We determine the time it takes for serum testosterone to return to normal after withdrawal of androgen deprivation therapy.
Serial serum testosterone was prospectively measured at 3-month intervals in 68 men after withdrawal of androgen deprivation therapy. The number of months to return to normal serum testosterone 270 ng./dl. or greater, was calculated for each patient. Patients were stratified according to duration of androgen deprivation, age and type of luteinizing hormone releasing hormone agonist used.
Median patient age was 71 years (range 46 to 88). Median time to normalization of testosterone was 7 months (range 1 to 58). At 3, 6 and 12 months 28%, 48% and 74% of men had normal serum testosterone, respectively. Serum testosterone took significantly longer to return to normal in patients on androgen deprivation therapy for 24 months or greater compared to those on therapy for less than 24 months (log-rank p = 0.0034). There was no statistical significance based on age or type of luteinizing hormone releasing hormone agonist used.
Androgen deprivation has an effect on serum testosterone that extends beyond the cessation of treatment. Serum testosterone should be measured in all men until normalization. These results should be applied to the interpretation of PSA levels after withdrawal of androgen deprivation therapy. In addition, these data have implications regarding dose scheduling and definition of biochemical (PSA) failure after primary therapy.
前列腺癌患者接受新辅助、辅助和间歇性雄激素剥夺治疗。在雄激素剥夺治疗期间前列腺特异性抗原（PSA）会发生变化，因此，在血清睾酮恢复正常之前测得的PSA值的预后意义和准确性存在疑问，因为患者仍在接受有效的雄激素剥夺治疗。我们确定雄激素剥夺治疗停止后血清睾酮恢复正常所需的时间。
前瞻性地对68名男性在停止雄激素剥夺治疗后每隔3个月测量一次血清睾酮。计算每位患者血清睾酮恢复至正常水平（270 ng./dl或更高）所需的月数。根据雄激素剥夺治疗的持续时间、年龄和使用的促黄体生成素释放激素激动剂类型对患者进行分层。
患者中位年龄为71岁（范围46至88岁）。睾酮恢复正常的中位时间为7个月（范围1至58个月）。在3个月、6个月和12个月时，分别有28%、48%和74%的男性血清睾酮恢复正常。与接受雄激素剥夺治疗少于24个月的患者相比，接受雄激素剥夺治疗24个月或更长时间的患者血清睾酮恢复正常所需的时间明显更长（对数秩检验p = 0.0034）。根据年龄或使用的促黄体生成素释放激素激动剂类型，差异无统计学意义。
雄激素剥夺对血清睾酮的影响在治疗停止后仍会持续。在所有男性血清睾酮恢复正常之前都应进行测量。这些结果应应用于雄激素剥夺治疗停止后PSA水平的解读。此外，这些数据对初始治疗后的剂量安排和生化（PSA）失败的定义具有重要意义。
