High 11-Ketotestosterone Linked to Shorter Time to Castration Resistance in Recurrent Nonmetastatic Prostate Cancer

The contribution of 11-oxygenated androgens to the progression of lethal prostate cancer (PCa) remains unresolved. We hypothesized that evaluating circulating levels of 11-oxygenated androgens, such as the androgen receptor agonist 11-ketotestosterone (11KT), could serve as a potential predictor of the onset of castration-resistant PCa (CRPC).

We used mass spectrometry to quantify 11-oxygenated androgens in postoperative plasma samples acquired from 145 patients who subsequently received androgen deprivation therapy for biochemical recurrence and achieved castrated testosterone levels. Kaplan-Meier survival analyses and multivariable Cox models were used to investigate relationships between steroids and CRPC.

Of 145 patients, 31 developed CRPC with a median time to CRPC of 57 months. 11-Oxygenated androgen levels were unaffected by androgen deprivation therapy, which stands in contrast to the observed changes in testosterone and other steroids. 11KT was the most abundant androgen but was not linked to clinical features. Kaplan-Meier analysis revealed that 11KT levels above the median of 273 pg/mL were associated with a shorter time to CRPC (P = .03). In multivariable analyses, this was supported with an adjusted HR of 2.17 (95% CI, 0.99-4.71; P = .05).

11KT is a key component of the hormonal profile predictive of earlier onset of CRPC. Enhancing our understanding of the specific role of 11KT in the progression to CRPC could help optimize hormonal therapy for castration-sensitive patients with PCa and CRPC.