Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL.
Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, IL.
Urol Oncol. 2025 Jan;43(1):65.e1-65.e8. doi: 10.1016/j.urolonc.2024.08.005. Epub 2024 Sep 5.
Finite courses of androgen deprivation therapy (ADT) are often utilized in men undergoing treatment for prostate cancer. Previous evidence suggests that timing of testosterone (T) recovery can be variable after ADT. Recently, an oral gonadotropin releasing-hormone (GnRH) antagonist, relugolix, has demonstrated more rapid T recovery than injectable GnRH agonists such as leuprolide. In this study, we sought to evaluate patient characteristics associated with T recovery in patients undergoing ADT of defined duration.
The Northwestern Enterprise Data Warehouse was queried for men with prostate cancer who completed a course of ADT and subsequently had a testosterone lab performed. Testosterone recovery was evaluated for levels that reached above castrate (T > 50 ng/dl), partial recovery (T > 150 ng/dl), and full recovery (T ≥ 300 ng/dl).
388 men who received finite courses of ADT were identified (348 receiving leuprolide, 36 receiving relugolix, and 4 receiving degarelix). In multivariable Cox regression analysis, men who were prescribed GnRH antagonists (HR = 3.74, CI = 2.53-5.53, P ≤ 0.001) and who were younger (HR for 1 year increase in age = 0.96, CI = 0.95-0.98, P < 0.001) were more likely to achieve partial recovery. In a subgroup analysis, men who received extended ADT courses (>12 months) with a GnRH agonist had lower rates of partial T recovery (HR = 0.58, CI = 0.41-0.81, P = 0.001).
T recovery after ADT is variable with roughly one sixth of men remaining castrate. GnRH antagonist use and younger age are associated with higher rates of T recovery after ADT. Longer ADT courses were associated with worse T recovery rates.
在接受前列腺癌治疗的男性中，常采用有限疗程的雄激素剥夺疗法（ADT）。先前的证据表明，ADT 后睾酮（T）的恢复时间可能有所不同。最近，一种口服促性腺激素释放激素（GnRH）拮抗剂——relugolix，已被证明比注射用 GnRH 激动剂（如 leuprolide）更快地恢复 T。在这项研究中，我们旨在评估接受规定疗程 ADT 的患者中与 T 恢复相关的患者特征。
通过西北企业数据仓库，查询了完成 ADT 疗程且随后进行了睾酮检测的前列腺癌男性患者。评估了达到去势（T＞50ng/dl）、部分恢复（T＞150ng/dl）和完全恢复（T≥300ng/dl）的 T 恢复情况。
共确定了 388 名接受有限疗程 ADT 的男性（348 名接受 leuprolide，36 名接受 relugolix，4 名接受 degarelix）。多变量 Cox 回归分析显示，接受 GnRH 拮抗剂治疗的男性（HR=3.74，CI=2.53-5.53，P≤0.001）和年龄较小（年龄每增加 1 年的 HR=0.96，CI=0.95-0.98，P＜0.001）的男性更有可能达到部分恢复。在亚组分析中，接受 GnRH 激动剂延长 ADT 疗程（＞12 个月）的男性，其部分 T 恢复率较低（HR=0.58，CI=0.41-0.81，P=0.001）。
ADT 后 T 的恢复情况各不相同，约有六分之一的男性仍处于去势状态。使用 GnRH 拮抗剂和较年轻的年龄与 ADT 后 T 恢复率较高相关。ADT 疗程较长与 T 恢复率较差相关。
