Testosterone suppression in the treatment of recurrent or metastatic prostate cancer - A Canadian consensus statement

Area of Science:

• Oncology
• Endocrinology
• Urology

Background:

• Androgen-deprivation therapy (ADT) is a cornerstone treatment for recurrent and metastatic prostate cancer.
• Testosterone suppression is key to ADT efficacy, with emerging evidence supporting lower testosterone levels.
• Current guidelines lack specific targets for castrate testosterone levels.

Purpose of the Study:

• To establish practical clinical guidelines for achieving and monitoring testosterone suppression in prostate cancer treatment.
• To recommend a new standard castrate testosterone level based on current evidence.
• To promote accurate testosterone measurement for effective ADT.

Main Methods:

• A pan-Canadian expert panel convened to review literature and develop consensus statements.
• Key clinical issues regarding testosterone suppression were identified and addressed.
• Recommendations were formulated based on synthesized evidence and clinical expertise.

Main Results:

• Current evidence supports the clinical benefit of achieving testosterone levels ≤0.7 nmol/l during ADT.
• The expert panel recommends adopting ≤0.7 nmol/l as the new standard castrate testosterone level.
• Regular monitoring of testosterone and PSA levels is advised, with strategy reassessment if targets are not met.

Conclusions:

• Adoption of ≤0.7 nmol/l as the standard castrate testosterone level is warranted for improved prostate cancer outcomes.
• Accurate testosterone measurement, preferably using mass spectrometry-based assays, is crucial for effective ADT.
• Enhanced awareness and education on testosterone assay specifications are needed for consistent clinical practice.