Intermittent Use of Testosterone Inactivating Pharmaceuticals Using Finasteride Prolongs the Time Off Period

Purpose

Men with prostate cancer treated intermittently with TIP benefit from improved quality of life when TOP with recovered testosterone is prolonged. We examined factors influencing the duration of TOP.

Materials and Methods

We retrospectively reviewed the charts of 101 men treated with intermittent TIP in a 9-year period. Men with positive bone scan, men in whom a PSA nadir of less than 0.1 ng/ml on TIP failed to be achieved and maintained and men in whom testosterone failed to recover to greater than 150 ng/dl during the first 12 months of TOP were excluded. Potential factors predicting prolonged TOP or accelerated time to AIPC were studied with Cox regression analysis.

Results

Patient characteristics were clinical stage T1c-T2a in 51 and T2b-T3b in 11, PSA relapse in 29, and T3c, D0 or D1 in 10. Median PSA was 7.6 ng/ml, Gleason score was 3 + 4 = 7 and TIP duration was 15.8 months. The 60 group 1 patients received finasteride and the 41 in group 2 received no finasteride. Median TOP in groups 1 and 2 was 31 and 15 months, respectively, using Kaplan-Meier analysis. Cox regression analysis indicated that longer TIP, finasteride and increased age predicted longer TOP. A slow PSA decrease while on TIP, higher baseline PSA and increased Gleason score predicted shorter TOP. Cox regression analysis indicated that only higher clinical stage but not finasteride predicted the earlier onset of AIPC.

Conclusions

Finasteride doubles the duration of TOP. AIPC was not increased by finasteride after almost 9 years of observation.

Key Words:  prostate , prostatic neoplasms , finasteride androgen antagonists

Abbreviations and Acronyms:  AIPC, androgen independent prostate cancer , BTESTO, testosterone before TIP , IPSA, PSA before TIP , LHRH, luteinizing hormone-releasing hormone , PSA, prostate specific antigen , RTESTO, recovered testosterone , TIP, testosterone inactivating pharmaceuticals , TOP, time off period , UDM, undetectable month