Testosterone Recovery and Quality of Life of Japanese Patients After Short-Term Neoadjuvant Androgen Deprivation Therapy With Low-Dose-Rate Brachytherapy for Prostate Cancer.

[OBJECTIVES] Androgen deprivation therapy is generally administered alongside radiation therapy for intermediate- or high-risk prostate cancer. However, this treatment results in low testosterone levels, even on a short-term basis. Additionally, after cessation, it may take up to a year for normal testosterone levels to return, which deteriorates quality of life. We investigated the time to testosterone recovery and its association with the hormonal quality of life.

[METHODS] This study included 210 patients at our hospital who received low-dose-rate brachytherapy with short-term (≤ 6 months) neoadjuvant androgen deprivation therapy. Testosterone recovery consisted of three stages: recovery to supracastrate level (serum total testosterone ≥ 0.5 ng/mL), recovery to nonhypogonadism level (serum total testosterone ≥ 1.31 ng/mL), and recovery to normal level (serum total testosterone ≥ 3 ng/mL).

[RESULTS] The median duration for androgen deprivation therapy was 4 months. The median times to testosterone recovery after cessation were 3.2, 4, and 12.1 months for supracastrate, nonhypogonadism, and normal levels, respectively. [Correction added on 28 March 2025, after first online publication: In the preceding sentence, the median times have been corrected from '3.3, 5.7, and 12.2 months' to '3.2, 4, and 12.1 months']. We used the Expanded Prostate Cancer Index Composite questionnaire to evaluate quality of life. The hormonal domain score deteriorated significantly after the initiation of low-dose-rate brachytherapy until 6 months after treatment and became comparable to the pre-treatment level after 12 months. We determined that the questionnaire subscales for hormonal function and bother domains returned to baseline at 12 and 6 months, respectively.

[CONCLUSIONS] Recovery of total testosterone level after androgen deprivation therapy cessation was a long-term process. The hormonal bother score improved earlier than the hormonal function score on subscales of the hormonal quality of life.