Influence of Hormone Therapy and Testosterone Level on All Cause Survival after Brachytherapy for Localized Prostate Cancer

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To determine the influence of neoadjuvant hormone therapy (NHT) and testosterone level (T) on all cause survival (ACS) following prostate seed implantation (PSI).


1776 men with a median age of 66 years (range 31-84) were followed a minimum of 6 years (mean 10.3, range 6-22.4) and had PSI alone or with neoadjuvant hormone therapy (NHT) and or external beam irradiation boost (EBRT). NHT was given to 948 (53.4%) for a median of 6 months (75%ile 3-9). T level was available in 1140 (64.2%) a median of 6.3 years (75%ile 3.2-9.2) following treatment. The presence of co-existing medical conditions including diabetes (AODM), coronary artery disease, alcohol use, asthma, atrial fib, other cancers, heart disease, hypertension, stroke and emphysema was determined pre-treatment. Associations were compared by two-way tables (Pearson chi-square). Survival was computed by Kaplan-Meier method with comparisons by log rank. Hazard rates (HR) were determined by Cox regression analysis.


ACS at 10 and 17 years were 88.5% and 52.9%. 10 and 17-year survival (table) was decreased with the use of NHT (p=0.004), for NHT >6 months (p<0.001), for age > 65 vs. ≤ 65 years (p<0.001), for AODM (p=0.018) and for last T < 300 ng/dL (p=0.001). None of the other comorbidities were significant. Of the 1140 men with T levels, 74 were on salvage HT. Exclusion of these men yielded a last mean T of 342.3 ng/dL (95%ile 44-645). Last T was 359.8 vs 299.7 ng/dL for men treated with 0-6 months NHT vs > 6 months (p<0.001). There were 59/440 (13.2%) deaths in men with a T<300 vs. 47/620 (7.6%) for T≥300 (OR 0.538, 95%CI 0.36-0.81, p=0.002). Cox regression HRs (ACS) were for age 0.284 (95% 0.172-0.469, p<0.001), NHT 0.548 (95%CI 0.382-0.786), last T≥300 1.451 (95%CI 1.014-2.076, p=0.042) and AODM 0.521 (95%CI 0.314-0.866). Cox regression HRs after exclusion of the 74 men on salvage HT were age 0.284 (p<0.001), and last T≥300 1.495 (p=0.023).</p>


A low testosterone level has a significant impact on ACS in men treated with PSI. NHT given for more than 6 months is associated with lower long-term T levels and a T < 300 ng/dL is an independent predictor of lower ACS.

Funding: none