scholarly journals Clinical Effect of Switching from a Luteinizing Hormone-Releasing Hormone Agonist to an Antagonist in Patients with Castration-Resistant Prostate Cancer and Serum Testosterone Level ≥ 20 ng/dl

2015 ◽  
Vol 9 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Norihito Soga ◽  
Takumi Kageyama ◽  
Yuji Ogura ◽  
Tomomi Yamada ◽  
Norio Hayashi

Introduction: The efficacy of conversion from a luteinizing hormone-releasing hormone agonist to an antagonist was evaluated prospectively in patients with castration-resistant prostate cancer. Materials and Methods: From October 2012 to December 2014, 8 cases with a serum testosterone level ≥ 20 ng/dl during following androgen deprivation therapy were enrolled and received degarelix monthly. The primary end-pointgoal was to determine the effective prostate-specific antigen response rate. The secondary end-pointgoal was to assess the proportion of cases with a decrease in serum testosterone level to < 20 ng/ml. Results: One patient achieved a complete response, with a prostate-specific antigen level of 0.02 ng/ml at the nadirend of the study. The effective response rate was 25.0% (2/8), and the proportion of cases with prostate-specific antigen decline was 62.5% (5/8). In 5/8 cases (5/8, 62.5%), serum testosterone levels declined to < 20 ng/dl. Conclusion: Switching to a luteinizing hormone-releasing hormone antagonist in patients with testosterone levels ≥ 20 ng/dl may be an option in sequential androgen deprivation therapy for some patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17545-e17545
Author(s):  
Maysa Tamara Silveira Vilbert ◽  
Marcelle Goldner Cesca ◽  
Natasha Carvalho Pandolfi ◽  
Vinicius Fernando Calsavara ◽  
Bruno Cezar de Mendonça Uchôa ◽  
...  

e17545 Background: Androgen receptor-targeted agents Abiraterone and Enzalutamide (Abi/Ez) prolonged overall survival in metastatic castration resistant prostate cancer (mCRPC). Patients with very-low serum testosterone levels seem to have less benefit from these therapies as well as more aggressive prostate cancer. Methods: A retrospective observational cohort study was conducted to evaluate whether a serum testosterone measured at time of start first-line therapy with Abi/Ez is related to overall survival (OS) and time-to-treatment failure (TTF) in mCRPC patients. Kaplan-Meier survival estimates and Cox-regression models were used for time-to-event analyses. The best cut-off for testosterone was defined using Log-rank statistics (Lausen and Schumacher). X² test and Mann-Whitney U-test were applied to compare categorical and continuous variables, respectively. Logistic regression was used to assess characteristics related to serum testosterone levels. Statistical significance was fixed at 0.05. Results: From May 2012 to February 2017, 100 patients were assessed. Median follow-up was 27.8 months (range 2.23 to 68.26). Pts with a high testosterone level ( > 28.2; n = 20) achieved a significantly higher OS (median 66.0 vs 31.9 mo, testosterone > 28.2 HR: 0.206, 95% CI 0.074 to 0.571, p = 0.002) and TTF (median 30.6 vs 11.8 mo, testosterone > 28.2 HR: 0.408, 95%CI 0.219 to 0.762, p = 0.005) than pts with a low serum testosterone level ( < 28.2; n = 80), regardless of receiving therapy with either Abi (n = 69) or Ez (n = 31). Pts with a higher testosterone level were younger (median 67.7 vs 73.6 years; p = 0.026), had a higher body mass index (BMI) (28.5 vs 25.9, p = 0.023) and a lower PSA at start Abi/Ez (12 vs 26, p = 0.031) than pts with lower values. Age (OR 0.93, 95%CI 0.8 to 0.9, p = 0.021), BMI (OR 1.21, 95%CI 1.1 to 1.4, p = 0.006) and baseline PSA (OR 1.2, 95%CI 1.03 to 1.4, p = 0.020) were significantly associated with testosterone > 28.2. After 4 months of Abi/Ez treatment, PSA decrease > 50% of baseline was seen more frequently in high testosterone levels group than in low testosterone levels pts (90% vs 57.5% of pts, respectively, p = 0.007). Conclusions: Pts with high levels of testosterone ( > 28.2) achieved a better OS and TTF when treated with Abi/Ez in first-line mCRPC than those with low levels. Testosterone can be considered a prognostic and predictive biomarker in this scenario, and could be used in treatment decision for this population.


2010 ◽  
Vol 63 (7-8) ◽  
pp. 479-482 ◽  
Author(s):  
Sasa Vojinov ◽  
Goran Marusic ◽  
Ivan Levakov ◽  
Jelena Popadic-Gacesa

% Karcinomi prostate % Antagonisti androgena % Kastracija % Testosteron % Luteinizirajuci hormone AB Introduction. The aim of this study was to investigate the influence of androgen blockades on prostate specific antigen (PSA) values in patients with locally advanced and metastatic prostatic cancer. Material and methods. The research was conducted on 60 patients. The group of 45 patients with prostatic cancer was divided into 3 subgroups, based on the type of the applied treatment protocol (15 patients on monotherapy with luteinizing hormone-releasing hormone agonists, 15 patients on total androgen blockade and 15 patients on monotherapy with antiandrogen). The control group consisted of 15 patients with benign prostatic hyperplasia. For all patients, the values of testosteron, luteinizing hormone and prostate specific antigen were monitored before as well as after 3 and 6 months during the treatment protocol. Results. All types of the applied treatment protocols in the therapy of prostatic cancer decreased the values of prostate specific antigen significantly The application of total androgen blockade and monotherapy with luteinizing hormone-releasing hormone agonists decreased the levels of prostate specific antigen significantly in comparison with monotherapy with antiandrogen. Conclusion. Although prostate specific antigen is not a prostatic cancer specific parameter, the dynamics of its decrease during the therapy of androgen blockade represents a significant marker of the therapy effect. Cilj rada je bio da se ispita uticaj androgenih blokada na vrednosti prostata specificnog antigena kod bolesnika sa lokalno uznapredovalim i metastatskim karcinomom prostate. Ispitivani uzorak se sastojao od 60 bolesnika. Grupa od 45 bolesnika sa karcinomom prostate bila je podeljena na tri podgrupe, u zavisnosti od primenjenog terapijskog protokola (15 bolesnika na monoterapiji agonistima luteinizirajuceg rilizing hormona, 15 bolesnika na totalnoj androgenoj blokadi i 15 bolesnika na monoterapiji antindrogenom). Kontrolnu grupu cinilo je 15 pacijenata sa benignom hiperplazijom prostate. Svim pacijentima su pracene vrednosti testosterona, luteinizirajuceg hormona i prostata specificnog antigena neposredno pre, kao i tri, to jest sest meseci nakon uvodjenja odgovarajuceg protokola. Sve tri vrste primenjenih terapijskih protokola u lecenju karcinoma prostate statisticki su znatno snizavale vrednosti prostata specificnog antigena u odnosu na pocetne vrednosti. Primena totalne androgene blokade i monoterapije agonistima luteinizirajuceg rilizing hormona dovela je do statisticki znatnog snizenja vrednosti prostata specificnog antigena u poredjenju sa monoterapijom antiandrogenom. Iako prostata specificni antigen nije specifican marker za karcinom prostate, dinamika njegove promene u toku androgene blokade predstavlja bitan pokazatelj terapijskog efekta.


Urology ◽  
2005 ◽  
Vol 65 (6) ◽  
pp. 1141-1145 ◽  
Author(s):  
Georg Schatzl ◽  
Michael Marberger ◽  
Mesut Remzi ◽  
Petra Grösser ◽  
Julia Unterlechner ◽  
...  

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