Interpreting Testosterone and Concomitant Prostate Specific Antigen Values during Androgen Deprivation Therapy for Recurrent Prostate Cancer.
Interpreting Testosterone and Concomitant Prostate Specific Antigen Values during Androgen Deprivation Therapy for Recurrent Prostate Cancer.
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解释复发性前列腺癌雄激素剥夺治疗期间睾酮和伴随的前列腺特异性抗原值。
DOI：
10.1097/ju.0000000000001946
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Toren,Paul
中科院分区：
文献类型：
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作者：
Tremblay,Samuel;Summers-Trasiewicz,Lily;Pouliot,Frédéric;Crook,JuanitaM;Ding,Keyue;Klotz,Laurence;Toren,Paul
在雄激素剥夺治疗（ADT）期间测量睾酮水平是广泛推荐的，但在ADT期间如何根据睾酮值改变治疗仍存在争议。因此，我们的目的是评估睾酮和伴随的前列腺特异性抗原（PSA）之间的关系材料和方法来自PR.7间歇ADT试验的持续雄激素剥夺组的患者，包括放疗后复发的前列腺癌。统计分析评价了ADT期间睾酮水平相对于伴随PSA水平的预后重要性。我们同样评估了睾酮突破的数量>1.7 nmol/l是否预测去势抵抗性前列腺癌（CRPC），癌症特异性生存期（CSS）或总生存期（OS）与Kaplan-Meier和考克斯回归analysis.ResultsOverall，睾酮对预后的重要性是黯然失色的伴随PSA值的预后价值。治疗第一年睾酮值>0.7 nmol/l的发生与随后升高>1.7 nmol/l相关，但每例患者睾酮突破的数量与CRPC、CSS或OS的风险无关。时间依赖性校正分析表明，PSA值具有预测性，但相对累积睾酮暴露量与结果无关。结论在这项长期随访的大规模试验中，突破性睾酮与CRPC的时间无关，CSS或OS。ADT治疗复发性前列腺癌期间的去势睾酮值提供了预后信息，必须与ADT开始后的时间和伴随的PSA值一起考虑。
PurposeMeasurement 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.Materials and MethodsPatients 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.ResultsOverall, 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.ConclusionsIn 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.