Defining a new testosterone threshold for medical castration: Results from a prospective cohort series

Authors

  • Shawn Dason Division of Urology, McMaster University
  • Christopher B. Allard Division of Urology, McMaster University
  • Justin Tong Division of Urology, McMaster University
  • Bobby Shayegan Division of Urology, McMaster University

DOI:

https://doi.org/10.5489/cuaj.471

Keywords:

testosterone measurement, androgen deprivation therapy, castration, castrate resistant prostate cancer, prostate cancer

Abstract

Background: We seek to determine if testosterone levels below the accepted castration threshold (50 ng/dL) have an impact on time to progression to castrate-resistant prostate cancer (CRPC).

Methods: This is a prospective cohort series of patients undergoing androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone agonist or antagonist at a tertiary centre from 2006 to 2011. Serum testosterone level was assessed every 3 months. Patients with any testosterone >50 ng/dL were excluded. Patients were stratified into groups based on those achieving mean testosterone levels <20 ng/dL and <32 ng/dL. Progression to CRPC was assessed with the Kaplan-Meier method and compared with the log-rank test.

Results: A total of 32 patients were included in this study. Mean patient follow-up was 25.7 months. Patients with a 9-month serum testosterone <32 ng/dL had a significantly increased time to CRPC compared to patients with testosterone 32 to 50 ng/dL (p = 0.001, median progression-free survival (PFS) 33.1 months [<32 ng/dL] vs. 12.5 months [>32 ng/dL]). Patients with first year mean testosterone <32 ng/dL also had a significantly increased time to CRPC compared to 32 to 50 ng/dL (p = 0.05, median PFS 33.1 months [<32 ng/dL] vs. 12.5 months [32-50 ng/dL]). A testosterone <20 ng/dL compared to 20 to 50 ng/dL did not significantly predict with time to CRPC.

Conclusion: This study supports a lower testosterone threshold to define optimal medical castration (T <32 ng/dL) than the previously accepted standard of 50 ng/dL. Testosterone levels during ADT serve as an early predictor of disease progression and thus should be measured in conjunction with prostate-specific antigen.

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Published

2013-05-13

How to Cite

Dason, S., Allard, C. B., Tong, J., & Shayegan, B. (2013). Defining a new testosterone threshold for medical castration: Results from a prospective cohort series. Canadian Urological Association Journal, 7(5-6), e263–7. https://doi.org/10.5489/cuaj.471

Issue

Section

Original Research

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