Department of Surgery, Faculty of Medicine, Université Laval; Centre de recherche CHU de Québec-Université Laval, Oncology Division, Quebec City, Quebec, Canada.
Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
J Urol. 2021 Nov;206(5):1166-1176. doi: 10.1097/JU.0000000000001946. Epub 2021 Jun 29.
Measurement of testosterone levels during androgen deprivation therapy (ADT) is broadly recommended, but how therapy should be altered in response to testosterone values during ADT remains controversial Our objective was therefore to evaluate the relation between testosterone and concomitant prostate specific antigen (PSA) levels during ADT on clinical outcomes.
Patients from the continuous androgen deprivation arm of the PR.7 trial of intermittent ADT for biochemically recurrent prostate cancer following radiotherapy were included. Statistical analyses evaluated the prognostic importance of testosterone levels during ADT relative to concomitant PSA levels. We similarly evaluated whether the number of testosterone breakthroughs >1.7 nmol/l predicted the time to castrate-resistant prostate cancer (CRPC), cancer specific survival (CSS) or overall survival (OS) with Kaplan-Meier and Cox regression analyses.
Overall, the prognostic importance of testosterone on outcomes was eclipsed by the prognostic value of concomitant PSA values. The occurrence of testosterone values >0.7 nmol/l in the first year of therapy was associated with subsequent rises >1.7 nmol/l, but the number of testosterone breakthroughs per patient had no relationship to the risk of CRPC, CSS or OS. A time-dependent adjusted analysis indicated as expected that PSA values were prognostic, but there was no association of relative cumulative testosterone exposure with outcomes.
In this large-scale trial with long followup, breakthrough testosterone was unrelated to time to CRPC, CSS or OS. Castrate testosterone values during ADT for recurrent prostate cancer provides prognostic information that must be considered alongside the time since ADT initiation and concomitant PSA values.
雄激素剥夺治疗（ADT）期间睾酮水平的测量被广泛推荐，但 ADT 期间睾酮值应如何改变以响应仍存在争议。我们的目的是评估 ADT 期间睾酮与同时的前列腺特异性抗原（PSA）水平与临床结果之间的关系。
纳入来自 PR.7 试验中连续 ADT 组的患者，该试验为放疗后生化复发的前列腺癌患者进行间歇性 ADT。统计分析评估了 ADT 期间睾酮水平相对于同时 PSA 水平的预后重要性。我们同样评估了睾酮突破> 1.7 nmol/L 的次数是否可以通过 Kaplan-Meier 和 Cox 回归分析预测去势抵抗性前列腺癌（CRPC）、癌症特异性生存（CSS）或总生存（OS）的时间。
总体而言，睾酮对结局的预后重要性被同时 PSA 值的预后价值所掩盖。治疗的第一年睾酮值> 0.7 nmol/L 与随后的> 1.7 nmol/L 升高有关，但每个患者的睾酮突破次数与 CRPC、CSS 或 OS 的风险无关。时间依赖性调整分析表明，预期 PSA 值具有预后意义，但相对累积睾酮暴露与结局无关。
在这项具有长期随访的大规模试验中，突破性睾酮与 CRPC、CSS 或 OS 的时间无关。ADT 期间治疗复发性前列腺癌的去势睾酮值提供了预后信息，必须与 ADT 开始后时间和同时 PSA 值一起考虑。
