The impact of persistent hypogonadism post-androgen deprivation therapy (ADT) on overall survival (OS) of patients with prostate cancer (PCa) is poorly documented. We compared OS between patients who recovered testosterone and those who did not after ADT.
Patients with PCa with intermediate- or high-risk disease were treated with ADT for 6, 18, or 36 months plus radiation therapy in 2 randomized trials. We compared OS between patients who recovered testosterone to a normal level to those who did not, using the log rank test. Multivariable Cox analysis to predict OS included recovered testosterone, age, Zubrod performance, comorbidities, baseline prostate specific antigen, Gleason score, stage, and ADT duration. To avoid immortal time bias, we performed a landmark analysis for each cohort.
The median follow-up was 16.6 years. Patients not recovering testosterone to a normal level were older, with more associated medical comorbidities. All the results are reported respectively for the 6-, 18-, and 36-month ADT cohorts. Testosterone recovery rates, to normal level, were 76.7%, 58.6%, and 45.3% with a median time to testosterone recovery of 1.64, 3, and 5 years, respectively. The 10-year OS rates were significantly higher in patients recovering testosterone: 77% versus 61%, P < .001; 73% versus 51%, P < .001; and 78% versus 62%, P < .001. However, multivariable analyses with landmark time points failed to show testosterone recovery as an independent predictor. The study is limited by its post hoc analysis.
In patients with PCa, our study shows that persistent hypogonadism post-ADT is associated with worse survival, particularly in older patients with medical conditions.
International journal of radiation oncology, biology, physics. 2025 Nov 23 [Epub ahead of print]
Abdenour Nabid, Nathalie Carrier, Éric Vigneault, André-Guy Martin, Thu Van Nguyen, Jean-Paul Bahary, Peter Vavassis, Boris Bahoric, Marc-André Brassard, Robert Archambault, François Vincent, Redouane Bettahar, Marie Duclos, Derek Wilke, Luis Souhami
Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada. Electronic address: ., Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada., CHU de Québec - Université Laval, Québec, Canada., Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada., Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada., Hôpital Général Juif de Montréal, Montréal, Québec, Canada., Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada., Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, Québec, Canada., Centre Hospitalier Régional de Trois-Rivières, Trois-Rivières, Québec, Canada., Centre de Santé et de Services Sociaux de Rimouski-Neigette, Rimouski, Québec, Canada., McGill University Health Centre, Montreal, Québec, Canada., Nova Scotia Cancer Center, Halifax, Nova Scotia, Canada.