Koo Kyo Chul, Lee Dong Hoon, Kim Kyu Hyun, Lee Seung Hwan, Hong Chang Hee, Hong Sung Joon, Chung Byung Ha
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. ; Sex Offender Treatment and Rehabilitation Center, National Forensic Hospital, Gongju, Korea.
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2014 May;55(3):570-5. doi: 10.3349/ymj.2014.55.3.570. Epub 2014 Apr 1.
To evaluate the kinetics of serum testosterone (T) recovery following short-term androgen deprivation therapy (ADT), as the understanding thereof is essential for the proper management of prostate cancer (PCa), especially intermittent ADT.
This prospective analysis included male sex offenders who voluntarily received leuprolide acetate in order to alleviate sexual aberrance. Thirty-three and 25 patients who received 3 and 6 months of ADT were assigned to Group A and Group B, respectively. Serum T levels were obtained every week during the on-cycle period, then monthly during the off-cycle period for at least 12 months.
The kinetics of serum T during the on-cycle period were similar in both groups. After flare reaction at week 2, a nadir of 0.45±0.29 ng/mL was achieved. In Group A, an abrupt rebound-upsurge was observed during the first 2 month off-cycle period, which surpassed the baseline level and reached a plateau level of 8.74±2.11 ng/mL during the flare (p<0.001). This upsurge was followed by a gradual decline back to baseline over the following 10 months. In Group B, a gradual increase was observed, and a baseline level of 7.26±1.73 ng/mL was reached at 5 months. Thereafter, an ongoing upsurge that surpassed baseline levels was observed until 12 months (8.81±1.92 ng/mL; p=0.002).
The kinetics of serum T recovery during the off-cycle period varied according to the duration of ADT. Serum T should be monitored beyond normalization, as an excessive rebound may improve quality-of-life, but hamper the treatment efficacy of PCa.
评估短期雄激素剥夺治疗（ADT）后血清睾酮（T）恢复的动力学，因为了解这一点对于前列腺癌（PCa）尤其是间歇性ADT的合理管理至关重要。
这项前瞻性分析纳入了自愿接受醋酸亮丙瑞林以减轻性异常行为的男性性犯罪者。分别将接受3个月和6个月ADT的33例和25例患者分为A组和B组。在治疗周期内每周测定血清T水平，然后在治疗周期外每月测定至少12个月。
两组在治疗周期内血清T的动力学相似。在第2周出现flare反应后，血清T最低点达到0.45±0.29 ng/mL。在A组，治疗周期外的前2个月观察到血清T突然反弹升高，超过基线水平，并在flare期间达到8.74±2.11 ng/mL的平台期水平（p<0.001）。随后在接下来的10个月中逐渐下降至基线水平。在B组，观察到血清T逐渐升高，在5个月时达到7.26±1.73 ng/mL的基线水平。此后，观察到血清T持续升高超过基线水平，直至12个月（8.81±1.92 ng/mL；p=0.002）。
治疗周期外血清T恢复的动力学因ADT持续时间而异。血清T应在恢复正常后继续监测，因为过度反弹可能改善生活质量，但会妨碍PCa的治疗效果。
