Taira Al V, Merrick Gregory S, Galbreath Robert W, Butler Wayne M, Adamovich Edward
Dorothy Schneider Cancer Center, Mills Penisula Hospital, San Mateo, CA.
Schiffler Cancer Center, Wheeling Jesuit University.
Am J Clin Oncol. 2018 Jul;41(7):667-673. doi: 10.1097/COC.0000000000000340.
To evaluate whether the use of androgen deprivation therapy (ADT) in prostate brachytherapy patients impacts overall mortality (OM) in patients with lower pretreatment serum testosterone levels compared with those with normal or high baseline serum testosterone.
From October 2001 to May 2014, 1916 patients underwent brachytherapy and had a pretreatment serum testosterone. Baseline serum testosterone values were collected prospectively before initiation of therapy. Median follow-up was 7.2 years. In total, 26% of the patients received ADT, primarily men with higher risk disease. OM and prostate cancer-specific mortality were examined to determine whether men with lower baseline serum testosterone were at increased risk of mortality when ADT was used, compared with men with baseline normal or higher testosterone.
Prostate cancer-specific mortality and OM at 10 years was 0.8% and 22.0%. Age, tobacco use, diabetes, cardiovascular disease, and percent positive biopsies were the strongest predictors of OM. ADT use by itself was not associated with an increased risk of OM on multivariate analysis (P=0.695). However, ADT use in men with lower baseline testosterone was associated with a significantly higher risk of OM (P<0.01). ADT use in men with normal or higher baseline testosterone was not associated with an increased OM risk (P=0.924).
Men with lower baseline testosterone may be at increased risk of premature death when ADT is utilized compared with men with baseline normal or higher testosterone. Further analysis of this potential risk factor is warranted to further identify subsets of men who may be at higher risk of long-term adverse sequelae from ADT.
评估在前列腺近距离放射治疗患者中，与基线血清睾酮水平正常或较高的患者相比，使用雄激素剥夺疗法（ADT）对治疗前血清睾酮水平较低的患者的总死亡率（OM）有何影响。
2001年10月至2014年5月，1916例患者接受了近距离放射治疗，并进行了治疗前血清睾酮检测。在治疗开始前前瞻性收集基线血清睾酮值。中位随访时间为7.2年。总共有26%的患者接受了ADT，主要是患有高风险疾病的男性。对总死亡率和前列腺癌特异性死亡率进行检查，以确定与基线睾酮水平正常或较高的男性相比，基线血清睾酮水平较低的男性在使用ADT时是否有更高的死亡风险。
10年时前列腺癌特异性死亡率和总死亡率分别为0.8%和22.0%。年龄、吸烟、糖尿病、心血管疾病和活检阳性百分比是总死亡率的最强预测因素。在多变量分析中，单独使用ADT与总死亡率增加无关（P = 0.695）。然而，基线睾酮水平较低的男性使用ADT与显著更高的总死亡率风险相关（P < 0.01）。基线睾酮水平正常或较高的男性使用ADT与总死亡率风险增加无关（P = 0.924）。
与基线睾酮水平正常或较高的男性相比，基线睾酮水平较低的男性在使用ADT时可能有更高的过早死亡风险。有必要对这一潜在风险因素进行进一步分析，以进一步确定可能因ADT而面临更高长期不良后果风险的男性亚组。
