Testosterone nadir and clinical outcomes in patients with advanced prostate cancer: Post hoc analysis of triptorelin pamoate Phase III studies.
Klotz. Laurence L; Tat. Tri T
Key Findings
- 96% of patients reached a testosterone nadir below 0.35 nmol/L with triptorelin.
- Lower nadir testosterone levels were associated with significantly better overall survival (p < 0.001).
- Disease‑specific survival improved with lower testosterone in sensitivity analyses, though primary analysis was not statistically significant.
Practical Outcomes
- For those experimenting with hormone modulation, the data suggest that very deep testosterone suppression can be beneficial in prostate cancer, but the risks and need for medical supervision outweigh any potential anti‑aging benefit for healthy individuals. Use of triptorelin should be limited to clinical settings under a doctor’s guidance.
Summary
In men with advanced prostate cancer, using the drug triptorelin to lower testosterone to very low levels (<0.35 nmol/L) was linked to longer overall survival, and possibly better cancer‑specific survival, compared to higher testosterone levels. The study shows deeper hormone suppression may improve outcomes in this disease, but the drug is prescription‑only and has significant side‑effects, so it isn’t a simple DIY anti‑aging tool for healthy people.
Abstract
The objective of the study is to evaluate whether low nadir testosterone during treatment with triptorelin pamoate, a luteinising hormone-releasing hormone (LHRH) agonist, is associated with improved clinical outcomes in patients with advanced prostate cancer using a retrospective analysis of clinical trial data. Data were pooled from three prospective, 9-12-month Phase III studies of triptorelin monotherapy in patients with advanced prostate cancer (including NCT00751790). The serum testosterone concentration suppression targets evaluated were <0.35 nmol/L (<10 ng/dl), <0.7 nmol/L (<20 ng/dl), <1.7 nmol/L (<50 ng/dl) and ≥1.7 nmol/L. Overall survival (OS) and disease-specific survival (DSS) by testosterone suppression group were assessed by Kaplan-Meier analysis, with log-rank test. The time frame for the primary analysis was Days 1-518 (median OS follow-up 254 days [range, 29-518 days]) and for the sensitivity analyses was Days 1-262. Supplementary analyses combined the ≥0.7- to <1.7-nmol/L and ≥1.7-nmol/L groups. The sample size comprised 592 patients (most received triptorelin monotherapy; four reported concomitant androgen receptor-axis-targeted therapy). Nadir testosterones of <0.35, ≥0.35 to <0.7, ≥0.7 to <1.7 and ≥1.7 nmol/L were achieved by 96%, 3.2%, 0.34% and 0.17% of patients, respectively. Better OS with decreasing level of nadir testosterone was observed (<i>p</i> < 0.001) and this persisted after sensitivity/supplemental analyses (all <i>p</i> < 0.001). Differences in DSS with decreasing levels of nadir testosterone were not statistically significant in the primary analysis. Sensitivity/supplemental analysis showed better DSS with decreasing level of nadir testosterone (Days 1-262, <i>p</i> = 0.01; combined groups Days 1-518, <i>p</i> = 0.03; combined groups Days 1-262, <i>p</i> = 0.005). Low nadir testosterone achieved during treatment with the LHRH agonist triptorelin was associated with improved OS and DSS in patients with advanced prostate cancer.
Study Information
pubmed
2024
2024-01-10T00:00:00.000Z
10.1002/bco2.318
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