MP53-05 TESTOSTERONE RECOVERY AFTER LONG TIME DEPRIVATION THERAPY: PREDICITIVE FACTORS AND MODELS (NOMOGRAMS)

Abstract

You have accessJournal of UrologyProstate Cancer: Advanced (including Drug Therapy) III1 Apr 2017MP53-05 TESTOSTERONE RECOVERY AFTER LONG TIME DEPRIVATION THERAPY: PREDICITIVE FACTORS AND MODELS (NOMOGRAMS) Fernando Estrada, Ángel García de Jalón, Angel Borque, Luis Esteban, Ma Jesús Gil, and Gerardo Sanz Fernando EstradaFernando Estrada More articles by this author , Ángel García de JalónÁngel García de Jalón More articles by this author , Angel BorqueAngel Borque More articles by this author , Luis EstebanLuis Esteban More articles by this author , Ma Jesús GilMa Jesús Gil More articles by this author , and Gerardo SanzGerardo Sanz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1656AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Chemical castration (Total Testosterone, TT,<0,50 ng/mL) is common treatment in intermediate/high risk prostate cancer (PCa) adjuvant to radiotherapy, and in advanced/metastatic PCa. After androgen deprivation therapy (ADT) we assume variability and delay until recovery over castration and/or eugonadic state (TT>3.5 ng/mL). We evaluate variability, associated factors, and the design of nomograms for TT recovery after ADT withdrawal. METHODS Ambispective study on 205 patients after ADT cessation. Predictive variables: age at initiation/cessation of ADT, biopsy/surgical specimen (in case) Gleason score, duration of ADT, primary therapy of PCa, and LHRH agonist. Result variables: Recovery of TT over castrate level and eugonadic level. Univariate analysis: Kaplan-Meier curves (log rank test). Multivariate models are built by Cox proportional hazards model. The calibration and the discrimination ability of the model, and probability density functions and clinical utility curves are evaluated. RESULTS The median biochemical and clinical follow-up are 27 (P25-75:15-39.5; Range: 1-98) and 39 months (P25-75:28-51; Range: 1-107 months). We find high individualised variabilty in TT recovery.- Recovery over castration levels: 25% of patients do not recover. Our intervals of recovery for 25, 50, 75 and 100% of recoverer patients are 4, 7, 10 and 42 months.- Recovery over eugonadic levels: 84% of patients do not normalize TT. After 12 months of ADT withdrawal only 8% of patients recovered normal levels, the maximum rate of recovery is at 32 months, no one patient recovered later on. In multivariate analysis “duration of ADT” and “age at ADT withdrawal” are significant predictors (H.R: 0.69, p=0.0002 and HR: 0.44, p<0.0001, for 0.5-Recovery; and HR:0.45,p=0.0006 and HR:0.39,p=0.0002, for 3.5-Recovery). We build two nomograms of recovery at 1, 2 and 3 years, with light overestimation for intermediate values in calibration analysis and a discrimination capacity ('c index') of 0.709 and 0.723, with AUC of 0.778, 0.813 and 0.805, and 0.707, 0.788 and 0.811 at 1, 2, and 3 years, respectively. CONCLUSIONS We confirmed a high variability in TT recovery after ADT withdrawal. We found as the most relevant predictors “duration of ADT” and “age at ADT withdrawal”. We obtained accurate calibrated and discriminative predictive nomograms of castration and eugonadic recovery. Those models would allow us to estimate and counsell functional recovery after adjuvant therapy, and to keep castration after ADT withdrawal or intermittency in a more cost-effectiveness practice. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e714 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Fernando Estrada More articles by this author Ángel García de Jalón More articles by this author Angel Borque More articles by this author Luis Esteban More articles by this author Ma Jesús Gil More articles by this author Gerardo Sanz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...