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Wong HMC, Chiu PKF, Puche-Sanz I, Xue Z, Chen DN, Gomez-Gomez E, Heidegger I, Kafka M, Wei Y, Sakamoto S, Ng ACF. Lower baseline testosterone level is related to earlier development of castration resistance in metastatic prostate cancer: a multi-center cohort study. Front Oncol 2024; 14:1321522. [PMID: 38444678 PMCID: PMC10913891 DOI: 10.3389/fonc.2024.1321522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Purpose In the era of concurrent combination therapy in metastatic hormone sensitive prostate cancer, the impact of the testosterone level before initiating androgen deprivation therapy on treatment outcome is still uncertain. We aimed to investigate its effect on time-to-castration-resistance in a metastatic hormone sensitive prostate cancer cohort. Methods This is a multi-center retrospective study of 5 databases from China, Japan, Austria and Spain including 258 metastatic hormone sensitive prostate cancer patients with androgen deprivation therapy initiated between 2002 and 2021. Baseline testosterone was divided into high and low groups using 12 nmol/L as cutoff level. Primary outcome was time-to-castration-resistance. Secondary outcomes were survival functions. Kaplan-Meier method was employed to evaluate the correlation between baseline testosterone and time-to-castration-resistance. Subgroup analysis was performed to elucidate the effect of upfront combination-therapy and metastatic volume. Results Median age was 72 years. Median follow-up time was 31 months. Median pre-treatment prostate-specific-antigen level was 161 ng/mL. Majority of case were graded as International-Society-of-Urological-Pathology grade 5 (63.6%). 57.8% patients had high volume disease and 69.0% received upfront combination treatment. 44.6% of the cohort developed castration-resistance. The low testosterone group demonstrated shorter mean-time-to-castration-resistance (19.0 vs 22.4 months, p=0.031). The variance was more significant in patients without combination therapy (13.2 vs 26.3 months, p=0.015). Cancer-specific and overall survival were inferior in the low baseline testosterone level group without receiving combination therapy (p=0.001). Conclusions Lower pre-treatment testosterone level is correlated to shorter time-to-castration resistance and worse survival in metastatic prostate cancer patients without upfront combination therapy. Those with low baseline testosterone should be encouraged to adopt combination therapy to delay progression.
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Affiliation(s)
- Ho Ming Chris Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Division of Urology, Department of Surgery, North District Hospital, Hong Kong, Hong Kong SAR, China
| | - Peter Ka-Fung Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Division of Urology, Department of Surgery, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Ignacio Puche-Sanz
- Department of Urology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Zhao Xue
- Department of Urology, Chiba University, Chiba, Japan
| | - Dong-Ning Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Enrique Gomez-Gomez
- Department of Urology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Isabel Heidegger
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Mona Kafka
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Yong Wei
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fujian, China
| | | | - Anthony Chi Fai Ng
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Division of Urology, Department of Surgery, North District Hospital, Hong Kong, Hong Kong SAR, China
- Division of Urology, Department of Surgery, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
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