Testosterone Recovery after Androgen Deprivation Therapy in Prostate Cancer: Building a Predictive Model.

PURPOSE: To analyze the variability, associated actors, and the design of nomograms for individualized testosterone recovery after cessation of androgen deprivation therapy (ADT). MATERIALS AND METHODS: A longitudinal study was carried out with 208 patients in the period 2003 to 2019. Castrated and normogonadic testosterone levels were defined as 0.5 and 3.5 ng/mL, respectively. The cumulative incidence curve described the recovery of testosterone. Univariate and multivariate analyzes were performed to predict testosterone recovery with candidate prognostic factors prostate-specific antigen at diagnosis, clinical stage, Gleason score from biopsy, age at cessation of ADT, duration of ADT, primary therapy and use of LHRH (luteinizing hormone-releasing hormone) agonists. RESULTS: The median follow-up duration in the study was 80 months (interquartile range, 49-99 mo). Twenty-five percent and 81% of patients did not recover the castrate and normogonadic levels, respectively. Duration of ADT and age at ADT cessation were significant predictors of testosterone recovery. We built two nomograms for testosterone recovery at 12, 24, 36, and 60 months. The castration recovery model had good calibration. The C-index was 0.677, with area under the receiver operating characteristic curve (AUC-ROC) of 0.736, 0.783, 0.782, and 0.780 at 12, 24, 36, and 60 months, respectively. The normogonadic recovery model overestimated the higher values of probability of recovery. The Cindex was 0.683, with AUC values of 0.812, 0.711, 0.708 and 0.693 at 12, 24, 36, and 60 months, respectively. CONCLUSIONS: Depending on the age of the patient and the length of treatment, clinicians may stop ADT and the castrated testosterone level will be maintained or, if the course of treatment has been short, we can estimate if it will return to normogonadic levels.

Parafinoma peneano: cirugía reconstructiva mediante matriz de colágeno e injerto utáneo / Penile paraffinoma: Reconstructive surgery with collagen matrix and skin grafts

No disponible

[Patient with testosterone deficit syndrome after external beam radiotherapy]. / Paciente con síndrome de déficit de testosterona tras radioterapia externa.

Testosterone deficit syndrome is a clinical and biochemical syndrome associated with advanced age and characterized by some symptomsassociated with serum testosterone levels deficiency, which may result in a decrease of quality of life and negatively affect the function of multiple organs or systems. Clinical guidelines recommend testosterone replacement therapy (TRT) in patients with testosterone decrease that associate muscle mass and strength loss, lumbar spinal column bone density decrease, or libido and erection decrease. Contraindications for treatment would include active prostate cancer or without treatment, PSA >4 ng/ml waiting for diagnostic workup, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe lower urinary tract symptoms secondary to benign prostatic hypertrophy. In certain situations there is still great controversy, without enough evidence to establish an action. References in case of patientstreated with brachytherapy or radiotherapy are unspecific: they only recommend caution in the treatment with TRT in these patients and strict monitoring of the possible recurrence. In our opinion, low-intermediate risk prostate cancer patients treated with radiotherapy only, without evidence of residual or recurrent disease, are candidates for TRT if symptoms justify it, leaving a free period of never less than one year after nadir (or 24 months after the end of therapy) which guarantees, on the possible means, the absence of biochemical or clinical recurrence,with strict follow up of clinical and biochemical usual parameters (hematocrit, hemoglobin, DRE, PSA).

Paciente con SDT tras radioterapia externa / Patient with testosterone deficit syndrome after external beam radiotherapy

El síndrome de déficit de testosterona es un síndrome clínico y bioquímico asociado a la edad avanzada y caracterizado por unos síntomas asociados con una deficiencia en los niveles de testosterona sérica, lo que puede resultar en una disminución de la calidad de vida y afectar de modo negativo a la función de múltiples órganos o sistemas. Las guías clínicas recomiendan el tratamiento sustitutivo con testosterona (TST) en pacientes con disminución de la misma y que asocien pérdida de masa muscular y fuerza, descenso de la densidad ósea en columna lumbar o disminución de la libido y erección. Las contraindicaciones para el tratamiento incluirían el cáncer de próstata activo o no tratado, el PSA > 4 ng/ml pendiente de valoración, el cáncer de mama, la apnea de sueño severa, la infertilidad, el hematocrito por encima de 50% o los síntomas severos del tracto urinario inferior debidos a hipertrofia prostática benigna. En determinadas situaciones existe todavía gran controversia, sin que dispongamos de niveles de evidencia suficientes para establecer una actuación. Las referencias en el caso de los pacientes tratados con braquiterapia o radioterapia son poco concretas: se aconseja únicamente la cautela en el tratamiento con TST de estos pacientes con monitorización estricta de la posible recidiva. En nuestra opinión, los pacientes tratados con radioterapia sola por cáncer de próstata de bajo o medio riesgo, sin evidencia de enfermedad residual o recidiva, son susceptibles de TST si la sintomatología lo justifica, dejando un período libre nunca inferior a un año tras su nadir (o 24 meses tras el final del tratamiento) que garantice, en la medida de lo posible, la ausencia de recidiva bioquímica o clínica, con seguimiento estricto de los parámetros clínicos y bioquímicos habituales (hematocrito, hemoglobina, TR, PSA) (AU)

Testosterone deficit syndrome is a clinical and biochemical syndrome associated with advanced age and characterized by some symptoms associated with serum testosterone levels deficiency, which may result in a decrease of quality of life and negatively affect the function of multiple organs or systems. Clinical guidelines recommend testosterone replacement therapy (TRT) in patients with testosterone decrease that associate muscle mass and strength loss, lumbar spinal column bone density decrease, or libido and erection decrease. Contraindications for treatment would include active prostate cancer or without treatment, PSA > 4 ng/ml waiting for diagnostic workup, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe lower urinary tract symptoms secondary to benign prostatic hypertrophy. In certain situations there is still great controversy, without enough evidence to establish an action. References in case of patients treated with brachytherapy or radiotherapy are unspecific: they only recommend caution in the treatment with TRT in these patients and strict monitoring of the possible recurrence. In our opinion, low-intermediate risk prostate cancer patients treated with radiotherapy only, without evidence of residual or recurrent disease, are candidates for TRT if symptoms justify it, leaving a free period of never less than one year after nadir (or 24 months after the end of therapy) which guarantees, on the possible means, the absence of biochemical or clinical recurrence, with strict follow up of clinical and biochemical usual parameters (hematocrit, hemoglobin, DRE, PSA) (AU)