Presentation Authors: Helen Levey Bernie*, Carolyn A. Salter, Elizabeth A Schofield, Nicole Benfante, John P Mulhall, NY, NY
Introduction: Testosterone therapy (TTH) in men with prostate cancer is controversial especially in men with high risk prostate cancer. This study assessed biochemical recurrence (BCR) rates in men with high risk prostate cancer.
Methods: We reviewed men who underwent radical prostatectomy (RP) with high risk prostate cancer (HRPC), defined as having a Gleason (GS) score of GS 6-7 with positive surgical margins (SMS+), lymph node involvement (LNI+), seminal vesicle involvement (SVI+) or GS â‰¥8 with any pathology status. BCR was defined as a prostate specific antigen (PSA) level of â‰¥ 0.1ng/mL. Low T was defined as an early morning total T (TT) < 300nd/dl. Men were divided into 3 groups based on T levels and TTH: those with normal TT levels and no TTH (NT); men with low TT who did not receive TTH; men with low TT who received TTH. Clinical and pathological data were analyzed. Chi-square and ANOVA were performed for group comparisons. A series of proportional hazards models were estimated to assess the unadjusted and adjusted associations of predictors to time-to-BCR. Each predictor was fitted in an unadjusted model, then significant predictors from unadjusted models were included in a single adjusted model.
Results: 1,407 men with HRPC were analyzed. Mean age = 61.7Â±7 years. 793 (56%) had normal TT (NT) levels with a mean TT of 481Â±156 ng/dL. 614 men had low TT levels (mean TT 136.2 Â± 113.5 ng/dL), 590 not on TTH (LTNT), and 24 on TTH (LTT). Among men with low TT levels, those on TTH did not differ significantly from those not on TTH, by pathology status, but had lower Gleason scores (p=0.010) and were less likely to be LNI positive (17% LTT, 41% LTNT, p =0.041). Of the men on TTH, 25% were â‰¥ GS 8; of the GS 6-7 patients, 63% were SMS+, 42% SVI+, 17% LNI+. In our cohort, a total of 906 (64%) patients experienced BCR within 0.1-15.3 years. 57% of the NT group, 75% in the LTNT group and 46% of men in the LTT group (LTNT compared to LTT p=0.001). Older age, higher Gleason score, LNI+, SVI+, receipt of chemotherapy, radiation, or ADT, low T and TTH were associated with faster BCR rates in unadjusted models. After adjustment, low T and TTH were not associated with BCR after covariate adjustment.
Conclusions: Men with HRPC with low T levels on TTH did not show an increased incidence of BCR when compared to men with HRPC who were not on TTH and men with normal TT levels.