Intermittent Androgen Suppression in Prostate Cancer: Testosterone Levels and Its Implication

Authors


Luigi Mearini, MD, Urology Department, University of Perugia, Sant'Andrea delle Fratte, Perugia 06100, Italy. Tel: 00390755784252; Fax: 00390755782454; E-mail: luigi.mearini@tin.it

ABSTRACT

Introduction.  Intermittent androgen suppression (IAS) in patients affected by prostate cancer seems to lessen the severity of the side effects that are associated with continuous androgen ablation.

Aim.  This report monitors the effect of IAS on testosterone values, quality of life, and sexual function during phases of therapy.

Methods.  A total of 100 patients entered a prospective study of IAS. Androgen blockade was prolonged until a serum prostate specific antigen (PSA) nadir was reached and then resumed for a PSA threshold of 10 ng/mL, in repeated cycles. During I phase, we assessed testosterone levels, well-being with quality-of-life score, and sexual function.

Main Outcome Measures.  All patients were followed up every 3 months with PSA and total testosterone determinations, and with quality-of-life score using a 10-point questionnaire. Side effects were assessed using yes/no questions. Sexual function was assessed using yes/no questions and in the sexually active patients with International Index of Erectile Function-5 (IIEF).

Results.  All patients completed I cycle of treatment (I ON plus I OFF phase). During the OFF phase, 46% of patients showed low testosterone levels, while the others recovered normal testosterone concentrations at a mean of 6.2 months after therapy. There is a negative correlation between baseline PSA values and length of OFF phase and testosterone recovery, and a negative correlation between length of OFF phase and testosterone value during OFF phase. Worsening in Quality of Life (QOL) was significant during active treatment with respect to baseline, but therapy withdrawal showed a positive impact with respect to treatment period. Improvement in quality of life correlated to testosterone recovery and time to testosterone recovery. Fifty-four percent of subjects had normal sexual intercourse at therapy withdrawal, with a correspondence to time to testosterone recovery.

Conclusions.  Quality of life and sexual function seem to follow testosterone normalization. These results could have implications in the analysis of IAS. Mearini L, Zucchi A, Costantini E, Bini V, and Porena M. Intermittent androgen suppression in prostate cancer: Testosterone levels and its implication. J Sex Med 2011;8:1218–1227.

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