Serum T increased signifcantly From baseline
in all subgroups. No change in PSA with TTh
was noted in the low risk group (0.00 to 0.00 ng/ml,
p
¼
0.48) or the intermediate risk group (0.09 to 0.09
ng/ml, p
¼
0.69). However, PSA increased signif-
cantly in the high risk group (0.10 to 0.36 ng/ml,
p
¼
0.018). PSAV was calculated in 82 men (83.7%).
Median PSAV in all patients was
e
0.0002 ng/ml per
year (IQR
e
0.0044
e
0.0018). There was no diFFer-
ence in PSAV among men with low, intermediate
and high risk CaP (p
¼
0.074, table 1).
Analysis by mode oF CaP treatment (EBRT,
brachytherapy and combined) revealed no signif-
cant diFFerences in mean PSA or PSAV even when
stratiFying by CaP treatment group. Men treated
with RT alone had a signifcant increase in PSA
From 0.08 to 0.09 ng/ml (p
¼
0.02) while men who
received RT plus ADT had no signifcant increase in
PSA (0.08 to 0.10 ng/ml, p
¼
0.70). PSAV was not
greater in men who did vs did not receive ADT
(
e
0.001 vs 0.000 ng/ml per year, p
¼
0.05).
Six men (6.1%) met criteria For BCR (table 2).
±our oF these men had biopsy results available,
including 2 with intermediate and 2 with high risk
CaP. ±our men were treated with brachytherapy
and 2 received EBRT. Three men had received ADT
and 3 had not. TTh was stopped in 3 men but
restarted in 1 aFter negative biopsy and imaging. Two
men were started on bicalutamide and an additional
patient was lost to Followup. Two patients underwent
biopsy in response to increasing PSA that did not
meet BCR criteria with neither biopsy demonstrating
CaP. An additional patient discontinued TTh due
to excessively high T while on injections (peak T
2,050 ng/ml) without an increase in PSA.
DISCUSSION
We present our multi-institutional experience with
TTh in 98 hypogonadal men treated with RT For
CaP. Despite a substantial increase in serum T with
TTh median PSA was unchanged overall. A small
but statistically signifcant increase in PSA was
observed in the high risk subgroup but not in men
with low or medium risk disease. Six patients (6.1%)
met BCR criteria.
To our knowledge the current study presents the
largest series to date oF hypogonadal men treated
with TTh aFter RT For CaP. It adds to growing evi-
dence that challenges the contraindication against
Table 2.
Characteristics of patients with BCR
Pt 1
Pt 2
Pt 3
Pt 4
Pt 5
Pt 6
Gl
7
Unknown
8
9
Unknown
7
ADT
No
No
Yes
Yes
Yes
No
RT type
Brachytherapy
EBRT
Brachytherapy
EBRT
Brachytherapy
Brachytherapy
RT end-TTh start (mos)
16
Not applicable
15
17
Not applicable
Not applicable
PSA (ng/ml):
TTh start
2.8
1.9
Less than 0.003
0.2
0.76
Less than 0.01
BCR workup max
3.8
3.6
2.2
5.3
4.7
4.5
Followup end
0.91
3.6
1.2
40
4.7
Less than 1.0
TTh stopped
No
No
Yes
Yes
No
Yes
Prostate biopsy
No
No
Yes (neg)
No
No
Yes (neg)
Computerized tomography
No
No
Yes (neg)
No
No
No
Bone scan
No
No
Yes (neg)
No
No
No
TTh restarted
Not applicable
Not applicable
Yes
No
Not applicable
No
Outcome
Not applicable
Not applicable
Not applicable
Bicalutamide
Lost to followup
Bicalutamide
Table 1.
Serum laboratory values and hypogonadal symptoms before and during TTh
Median Overall (IQR)
Median Gl (IQR)
6 or Less
7
8 or Greater
No. pts
98
47
28
11
PSA (ng/ml):
Baseline
0.08
(0.00
e
0.33)
0.00
(0.00
e
0.20)
0.09
(0.00
e
0.65)
0.10
(0.00
e
0.20)
Followup
0.09
(0.00
e
0.60)
0.00
(0.00
e
0.18)
0.09
(0.00
e
0.65)
0.36
(0.00
e
0.70)
p Value
0.051
0.434
0.698
0.018
T (ng/dl):
Baseline
209.0
(152
e
263)
220.0
(158
e
261)
179.0
(147
e
259)
229.0
(62
e
275)
Followup
420.0
(231
e
711)
415.0
(219
e
667)
378.5
(233
e
739)
747.0
(289
e
978)
p Value
<
0.001
<
0.001
0.001
0.003
FT (ng/dl):
Baseline
5.9
(4.4
e
9.4)
7.6
(5.7
e
27.8)
8.5
(4.9
e
13.9)
3.7
(0.9
e
5.6)
Followup
10.7
(4.9
e
29.5)
13.9
(7.8
e
49.4)
6.4
(4.3
e
47.2)
8.8
(3.6
e
34.5)
p Value
0.001
0.401
0.310
0.028
PSAV (ng/ml/yr)
0.000 (
±
0.004
e
0.002)
±
0.002 (
±
0.007
e
0.000)
0.000 (
±
0.005
e
0.000)
0.000 (0.000
e
0.639)
TESTOSTERONE THERAPY AFTER RADIATION THERAPY FOR PROSTATE CANCER
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