Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors

Ali Can Albaz; Oğuzcan Erbatu; Oktay Üçer; Gökhan Temeltaş; Talha Muezzinoglu

Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors

Abstract

Objective: To evaluate the incidence, clinical characteristics, and associated factors of clinical flare-up during the first 30 days after initiation of androgen deprivation therapy (ADT) in patients with prostate cancer. Methods: In this retrospective single-center study, 168 patients who initiated ADT between March 2023 and March 2026 were included. Factors associated with clinical flare-up were evaluated using univariate logistic regression analysis. Results: Clinical flare-up occurred in 14 patients (8.3%), with most events developing during the first week after ADT initiation. Higher baseline prostate-specific antigen (PSA) levels, bone metastasis, vertebral involvement, and the presence of baseline lower urinary tract symptoms were associated with clinical flare-up. Concomitant bicalutamide use was associated with a lower risk of clinical flare-up. Conclusion: Clinical flare-up is an important early complication of ADT despite its relatively low incidence. Identifying high-risk patients before treatment initiation and implementing appropriate preventive strategies may help prevent early complications and optimize patient management.

Keywords

Supporting Institution

The authors received no financial support from any funding agency, commercial entity, or not-for-profit organization for the conduct of this study.

Project Number

Not applicable

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Health Sciences Ethics Committee of Manisa Celal Bayar University Faculty of Medicine (Approval No. 20.478.486/3709; Approval Date: December 24, 2025). Because of the retrospective nature of the study and the use of anonymized data, the requirement for informed consent was waived by the Ethics Committee.

Thanks

None

References

Azad, A. A., Kostos, L., Agarwal, N., Attard, G., Davis, I. D., Dorff, T., Gillessen, S., Parker, C., Smith, M. R., Sweeney, C. J., Tombal, B., & Fizazi, K. (2025). Combination therapies in locally advanced and metastatic hormone-sensitive prostate cancer. European Urology, 87(4), 455–467. https://doi.org/10.1016/j.eururo.2025.01.010
Bray, F., Laversanne, M., Sung, H., Ferlay, J., Siegel, R. L., Soerjomataram, I., & Jemal, A. (2024). Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74(3), 229–263. https://doi.org/10.3322/caac.21834
Conteduca, V., Poti, G., Caroli, P., Russi, S., Brighi, N., Lolli, C., Schepisi, G., Romeo, A., Matteucci, F., Paganelli, G., Marchetti, P., & De Giorgi, U. (2021). Flare phenomenon in prostate cancer: recent evidence on new drugs and next-generation imaging. Therapeutic Advances in Medical Oncology, 13, 1758835920987654. https://doi.org/10.1177/1758835920987654
George, D. J., & Dearnaley, D. P. (2021). Relugolix, an oral gonadotropin-releasing hormone antagonist for the treatment of prostate cancer. Future Oncology, 17(33), 4431–4446. https://doi.org/10.2217/fon-2021-0575 Hussain, M., Fizazi, K., Shore, N. D., Heidegger, I., Smith, M. R., Tombal, B., & Saad, F. (2024). Metastatic hormone-sensitive prostate cancer and combination treatment outcomes: a review. JAMA Oncology, 10(6), 807–820. https://doi.org/10.1001/jamaoncol.2024.0591
James, N. D., Tannock, I., N'Dow, J., Feng, F., Gillessen, S., Ali, S. A., Trujillo, B., Al-Lazikani, B., Attard, G., Bray, F., Compérat, E., Eeles, R., Fatiregun, O., Grist, E., Halabi, S., Haran, Á., Herchenhorn, D., Hofman, M. S., Jalloh, M., ... Xie, L. P. (2024). The Lancet Commission on prostate cancer: planning for the surge in cases. The Lancet, 403(10437), 1683–1722. https://doi.org/10.1016/S0140-6736(24)00651-2
Lazo, A., Blanco, M., Ocanto, A., Duque-Santana, V., Del Castillo, R., Barrado, M., Zafra, J., López-Campos, F., & Couñago, F. (2025). GnRH antagonists: current evidence and role in prostate cancer. Archivos Españoles de Urología, 78(6), 642–652. https://doi.org/10.56434/j.arch.esp.urol.20257806.87
Nasser, N. J., Sun, K., Scanlon, K. M., Mishra, M. V., & Molitoris, J. K. (2022). Administering docetaxel for metastatic hormone-sensitive prostate cancer 1–6 days compared to more than 14 days after the start of LHRH agonist is associated with better clinical outcomes due to androgen flare. Cancers, 14(4), 864. https://doi.org/10.3390/cancers14040864
Nishimura, K. (2023). Management of bone metastasis in prostate cancer. Journal of Bone and Mineral Metabolism, 41(3), 317–326. https://doi.org/10.1007/s00774-023-01435-w

Raval, A. D., Chen, S., Littleton, N., Constantinovici, N., & Goebell, P. J. (2025). Real-world use of androgen-deprivation therapy intensification for metastatic hormone-sensitive prostate cancer: a systematic review. BJU International, 135(3), 408–421. https://doi.org/10.1111/bju.16577
Raychaudhuri, R., Lin, D. W., & Montgomery, R. B. (2025). Prostate cancer: a review. JAMA, 333(16), 1433–1446. https://doi.org/10.1001/jama.2025.0228
Shirley, M. (2023). Relugolix: a review in advanced prostate cancer. Targeted Oncology, 18(2), 295–302. https://doi.org/10.1007/s11523-022-00944-4
Spratt, D. E., Srinivas, S., Adra, N., Ahmed, B., An, Y., Bitting, R., Chapin, B., Cheng, H. H., Cho, S. Y., D'Amico, A. V., Desai, N., Dorff, T., Eastham, J. A., Farrington, T. A., Gao, X., Gupta, S., Ippolito, J. E., Karnes, R. J., Kishan, A., ... Freedman-Cass, D. (2025). Prostate cancer, version 3.2026, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network, 23(11), 469–493. https://doi.org/10.6004/jnccn.2025.0052
Tilki, D., van den Bergh, R. C. N., Briers, E., Van den Broeck, T., Brunckhorst, O., Darraugh, J., Eberli, D., De Meerleer, G., De Santis, M., Farolfi, A., Gandaglia, G., Gillessen, S., Grivas, N., Henry, A. M., Lardas, M., van Leenders, G. J. L. H., Liew, M., Linares Espinos, E., Oldenburg, J., ... Cornford, P. (2024). EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines on prostate cancer. Part II—2024 update: treatment of relapsing and metastatic prostate cancer. European Urology, 86(2), 164–182. https://doi.org/10.1016/j.eururo.2024.04.010
Van Poppel, H., & Abrahamsson, P. A. (2020). Considerations for the use of gonadotropin-releasing hormone agonists and antagonists in patients with prostate cancer. International Journal of Urology, 27(10), 830–837. https://doi.org/10.1111/iju.14303

Details

Primary Language

English

Subjects

Surgery (Other), Primary Health Care

Journal Section

Research Article

Authors

Ali Can Albaz ^*
0000-0002-7725-1241
Türkiye

Oğuzcan Erbatu
0000-0002-2840-0028
Türkiye

Oktay Üçer
0000-0001-7912-0408
Türkiye

Gökhan Temeltaş
0000-0001-7673-2206
Türkiye

Talha Muezzinoglu
0000-0001-7799-008X
Türkiye

Publication Date

September 30, 2026

Submission Date

July 22, 2026

Acceptance Date

August 25, 2026

Published in Issue

Year 2026 Volume: 13 Number: 3

IZ

https://izlik.org/JA92TD67PR

Cite

RIS / Bibtex

APA

Albaz, A. C., Erbatu, O., Üçer, O., Temeltaş, G., & Muezzinoglu, T. (2026). Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal, 13(3), 406-419. https://izlik.org/JA92TD67PR

AMA

1.Albaz AC, Erbatu O, Üçer O, Temeltaş G, Muezzinoglu T. Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal. 2026;13(3):406-419. https://izlik.org/JA92TD67PR

Chicago

Albaz, Ali Can, Oğuzcan Erbatu, Oktay Üçer, Gökhan Temeltaş, and Talha Muezzinoglu. 2026. “Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors”. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal 13 (3): 406-19. https://izlik.org/JA92TD67PR.

EndNote

Albaz AC, Erbatu O, Üçer O, Temeltaş G, Muezzinoglu T (September 1, 2026) Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal 13 3 406–419.

IEEE

[1]A. C. Albaz, O. Erbatu, O. Üçer, G. Temeltaş, and T. Muezzinoglu, “Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors”, CBU-SBED: Celal Bayar University-Health Sciences Institute Journal, vol. 13, no. 3, pp. 406–419, Sept. 2026, [Online]. Available: https://izlik.org/JA92TD67PR

ISNAD

Albaz, Ali Can - Erbatu, Oğuzcan - Üçer, Oktay - Temeltaş, Gökhan - Muezzinoglu, Talha. “Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors”. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal 13/3 (September 1, 2026): 406-419. https://izlik.org/JA92TD67PR.

JAMA

1.Albaz AC, Erbatu O, Üçer O, Temeltaş G, Muezzinoglu T. Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal. 2026;13:406–419.

MLA

Albaz, Ali Can, et al. “Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors”. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal, vol. 13, no. 3, Sept. 2026, pp. 406-19, https://izlik.org/JA92TD67PR.

Vancouver

1.Ali Can Albaz, Oğuzcan Erbatu, Oktay Üçer, Gökhan Temeltaş, Talha Muezzinoglu. Clinical Flare-Up After Androgen Deprivation Therapy in Prostate Cancer: Incidence and Associated Factors. CBU-SBED: Celal Bayar University-Health Sciences Institute Journal [Internet]. 2026 Sep. 1;13(3):406-19. Available from: https://izlik.org/JA92TD67PR