MP36-01 TESTOSTERONE (T) CHALLENGE IN MEN POST-RADICAL PROSTATECTOMY (RP) WITH PROFOUNDLY LOW TESTOSTERONE

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (MP36)1 Sep 2021MP36-01 TESTOSTERONE (T) CHALLENGE IN MEN POST-RADICAL PROSTATECTOMY (RP) WITH PROFOUNDLY LOW TESTOSTERONE John P. Mulhall, Serkan Deveci, Jose Flores, Kazuhito Matsushita, Jose Torremade, and Carolyn A. Salter John P. MulhallJohn P. Mulhall More articles by this author , Serkan DeveciSerkan Deveci More articles by this author , Jose FloresJose Flores More articles by this author , Kazuhito MatsushitaKazuhito Matsushita More articles by this author , Jose TorremadeJose Torremade More articles by this author , and Carolyn A. SalterCarolyn A. Salter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002045.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate specific antigen is the primary marker of prostate cancer recurrence. PSA secretion is T dependent with T levels below saturation point associated with sub-optimal PSA production. Men with an undetectable PSA level after RP with very low T levels might have an artificially low PSA level. We aimed to evaluate the effects of raising T level in such men. METHODS: Study population consisted of (i) men post-RP (ii) with undetectable PSA level (iii) total T levels <200 ng/dl (two levels, LCMS) who (iv) underwent in-office intramuscular injection of 100mg of T cypionate (v) had a PSA level checked 5 days later, and if undetectable every month after that, 3 months later then every 6 months and (vi) follow-up of at least 24 months on T therapy. RESULTS: 22 men have been challenged thus far. Mean age 62±18 years. Mean preoperative PSA 6.2. Mean post-RP TT value 140±35 ng/dL 2.2. Median Gleason sum 7. 23% had GS ≥8. Mean post-RP, pre-challenge T value 140± 35 ng/dL. Mean time post-RP to challenge was 7±9 months. Mean TT value 5 days after IMT challenge 640±220 ng/dL, all with TT levels above 400. 5/22 has a PSA elevation, 2 immediately after IMT challenge (PSA values 0.07, 0.08). All other men started T therapy immediately and had PSA elevation at 9, 14 and 22 months after commencing T therapy (PSA values 0.08, 0.12, 0.11). All patients with PSA elevation had continued rise in PSA and had detectable disease on imaging. All men with PSA recurrence had either GS 7 with unfavorable pathology (2) or GS ≥8 (3). CONCLUSIONS: This T challenge approach permits the early detection of prostate cancer recurrence permitting early intervention. About 10% of such men had a PSA rise immediately after T challenge. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e636-e636 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John P. Mulhall More articles by this author Serkan Deveci More articles by this author Jose Flores More articles by this author Kazuhito Matsushita More articles by this author Jose Torremade More articles by this author Carolyn A. Salter More articles by this author Expand All Advertisement Loading ...