Biopsy Gleason score and the duration of testosterone suppression among men treated with external beam radiation and 6 months of combined androgen blockade

• Published in: BJU international Vol. 110; no. 9; pp. 1252 - 1256
• Main Authors: Martin, Neil E., Chen, Ming‐Hui, Nguyen, Paul L., Beard, Clair J., Loffredo, Marian J., Kantoff, Philip W., D'Amico, Anthony V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2012; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Androgen Antagonists - therapeutic use; androgen blockade; Androgens; Anilides - therapeutic use; Antineoplastic Agents, Hormonal - therapeutic use; Biological and medical sciences; Biopsy; Combined Modality Therapy - methods; Confidence intervals; Drug Therapy, Combination - methods; Flutamide - therapeutic use; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Middle Aged; Neoplasm Grading; Nephrology. Urinary tract diseases; Nitriles - therapeutic use; Prospective Studies; Prostate - pathology; Prostate cancer; prostatic neoplasms; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Radiation therapy; radiotherapy; Testosterone; Testosterone - antagonists & inhibitors; Tosyl Compounds - therapeutic use; Tumors; Tumors of the urinary system; Urinary tract. Prostate gland; Histological grading; Gleason score; Prostate tumor; Nephrology; Prostate disease; Suppression; Male; Urology; Extracorporeal irradiation; Histopathology; Adult; Testicular hormone; Male genital diseases; androgen blockade; Human; Urinary system disease; Androgen deprivation therapy; Androgen; Duration; Radiotherapy; Testosterone; Anatomic pathology; Biopsy; prostatic neoplasms; Sex steroid hormone
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2012.11118.x

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The return of testosterone to normal levels following short‐course androgen blockade in prostate cancer is variable. Factors associated with a longer time to recovery include older age and lower baseline testosterone level. In this study, we found that among men treated with 6 months of combined androgen blockade and radiation therapy, higher biopsy Gleason grade was associated with a shorter time to testosterone normalization. OBJECTIVE •  To determine whether the biopsy Gleason score is associated with duration of testosterone suppression following 6 months of combined androgen blockade (CAB) and radiation therapy (RT) in men with prostate cancer (PCa). PATIENTS AND METHODS •  The study cohort consisted of 221 men with PCa treated with RT and 6 months of CAB between 1996 and 2005. •  We defined the duration of testosterone suppression as the time between the last day of CAB and the date the testosterone returned to ≥252 ng/dL. We used Cox regression multivariable analysis to relate biopsy Gleason score to duration of testosterone suppression following cessation of CAB. RESULTS •  A biopsy Gleason score of 8–10 had an adjusted hazard ratio (AHR) of 1.56 (95% confidence interval [CI] 1.04, 2.34; P= 0.03) for a shorter time to testosterone normalization relative to Gleason 6. Specifically, the 51 men with biopsy Gleason score of 8–10 had a median time to testosterone normalization of 17.0 months compared with 22.1 months and 23.8 months for those with biopsy Gleason ≤6 and 7, respectively. •  Increasing age was significantly associated with a longer duration of testosterone suppression (AHR of 0.95 [95% CI 0.92, 0.97; P < 0.001]) as was a higher baseline PSA (AHR 0.82 [95% CI 0.69, 0.97; P= 0.02]). CONCLUSION •  A biopsy Gleason score of 8–10 was associated with a shorter period of testosterone suppression following 6 months of CAB and RT. These data are consistent with the hypothesis that a factor released from high‐grade PCa cells may impact on testosterone production.