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 3.3, 5.7, and 12.2 months for supracastrate, nonhypogonadism, and normal levels, respectively. 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.