SUBSTITUTION ANDROGEN THERAPY AFTER RADICAL TREATMENT OF PROSTATE CANCER

Abstract

Introduction. The question of safety and efficacy of hormonal therapy with androgen deficiency after successful treatment of the prostate cancer (PC) remains debatable, despite the availability of data of the lack of correlation between the level of endogenous testosterone and the risk of developing PC or even reducing the risk of testosterone replacement therapy (TRT).Objective: a preliminary assessment of the possibility of using the TRT in men with androgen deficiency syndrome after radical treatment of PC – brachytherapy and radical prostatectomy (RP).Materials and methods. At the bases of North-Western State Medical University n. a. I.I. Mechnikov examined 12 men aged 50 to 65 years with history localized PC (T1-2N0M0) and symptoms of androgenic deficiency: 5 patients after brachytherapy (all with Т1сN0M0G ) and 7 after RP (1 with Т2aN0M0G , 6 with Т1сN0M0G ). All patients were prescribed TRT in transdermal form (1 % gel) for 15 months.Before and after TRT determined the total level testosterone in blood, prostate-specific antigen; was performed the evaluation of erectile dysfunction according to the IIEF (International Index оf Erectile Function) and of androgen deficiency according to the AMS (Aging Males’ Symptoms Scale), transrectal ultrasound, multislice computed tomography or magnetic resonance imaging and osteoscintigraphy. Clinical data were not processed by statistical methods due to insufficient number of observations. The actual average value of indicators is given. Further accumulation of sufficient number of cases for the statistical analysis and check of efficiency and safety of the investigated therapy is planned.Results. After TRT the average level of total testosterone increased compared to baseline in patients undergoing brachytherapy, from 3.4 to 18.4 nmol/l, in patients undergoing RP, from 2.7 to 15.3 nmol/l; the level of the prostate-specific antigen decreases from 2.1 to 1.7 ng/ml and from 1.9 to 1.3 ng/ml. Evaluation according to the AMS after TRT decreased in comparison with the initial in patients who underwent brachytherapy from 43 to 20 points, in patients who underwent RP – from 47 to 23 points, which indicated a change in the degree of androgen deficiency from severe to mild; evaluation of IIEF increased from 10 to 19 points, accordingly, and from 8 to 17 points, which reflected a change in the degree of erectile dysfunction from severe to mild. According to control transrectal ultrasound, multislice computed tomography, magnetic resonance imaging, and osteoscintigraphy, there has been detected no progress and recurrence of the tumor process.Conclusion. In patients with androgen deficiency syndrome after radical PC treatment, TRT is possible, since it is associated with improvement of erectile function and reduction of androgen deficiency and does not lead to relapse of the tumor.

Keywords

• prostate cancer
• age-related androgen deficiency
• testosterone
• substitution therapy
• radical prostatectomy
• brachytherapy