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Assessing the Incidence of Escapes of Testosterone in the Treatment with LHRH Analogs: Escape Study

2009; Elsevier BV; Volume: 75; Issue: 3 Linguagem: Inglês

10.1016/j.ijrobp.2009.07.814

1879-355X

A. Cabeza, Antonio Gómez, S. Vilar, R. Córdoba García, M. Casaña, Pedro J. Prada, Yesenia Alejandra Ardila Rios, M.aM. Romero Pérez, R. Muelas, José Muñóz,

Hormonal and reproductive studies

Long-acting luteinizing analogs have become the most widely used drugs to achieve androgen deprivation with an efficacy comparable to orchidectomy in patients with advanced prostate cancer (PCa). Sometimes cases of failure to achieve androgen deprivation arise, testosterone escapes, but no study has so far sought to obtain the real incidence and studied the factors related to this issue. We designed an observational retrospective study in a longitudinal historic cohort to determine the status of a large number of patients with PCa without metastases who had been treated with LHRH analogs. The objective was to assess the incidence of therapeutic failure to achieve testosterone levels below 50 ng/dl with long-lasting LHRH analogs in routine clinical practice. Also to determine the most frequent factors related to testosterone escapes. We designed an observational, retrospective and multicentre study in a longitudinal historic cohort of patients with PCa treated with LHRH analogs conducted on a national scale, in 7 Radiation Oncology Units in Spain covering patients treated during a period of the last 2 years. Data were obtained from individual patient survey completed with the data from the medical chart. Out of data collected from 494 patients 451 were assessed. Mean age was 68.9 years (range 45 to 89 years), 64.8% had Gleason score of ≥7, 71.9% stage II and 28.1% stage III. 93.1% were treated with combined therapy with antiandrogens and 57.4% were treated with maximum androgen blockage during more than 30 days. We observed 50 cases of failure to achieve testosterone levels <50 ng/dl (11.0%). We also found differences in obese patients (BMI ≥30) but no differences were observed regarding age, comorbidity, initial PSA level, prostate volume. Out of these 50 cases 8 patients (7.5%) were treated with leuprorelin microspheres 22.5mg, followed by 12 patients with triptorelin 11.25 mg (9.6%), 13 patients with goserelin 10.8 mg (9.6%) and 17 patients (14.5%) with leuprorelin Atrigel 22.5mg. Finally the range of medians of testosterone regarding the treatment with different LHRH analogs was between 10.0 and 10.5 ng/dl. In common medical practice we have found an 11% of incidence of escapes in patients with PCa treated with LHRH analogs. In our sample LHRH analogs obtained a similar level of testosterone. We observed the BMI as a predictive factor.