Beyond castration: defining maximal testosterone control in advanced prostate cancer

Area of Science:

• Urology
• Oncology
• Endocrinology

Background:

• Androgen deprivation therapy (ADT) is standard for advanced prostate cancer.
• The definition of castration-level testosterone (typically <50 ng/dL) may need refinement for optimal treatment response assessment.

Purpose of the Study:

• To investigate the correlation between minimum testosterone (T) levels during ADT and prostate cancer progression and prognosis.
• To establish a new, potentially lower, threshold for defining castration-level testosterone.

Main Methods:

• Retrospective analysis of 425 advanced prostate cancer patients undergoing ADT.
• Stratification into groups based on lowest T levels: castration low (<10 ng/dL), castration (10-50 ng/dL), and non-castrated (>50 ng/dL).
• Subgroup analysis of ultra-low (<5 ng/dL) and extreme-low (5-10 ng/dL) T levels, and a cohort of surgically castrated patients.

Main Results:

• Significant differences in time to progression (TTP) and survival rates across T level groups (P<0.001).
• The castration low T group (<10 ng/dL) showed the longest TTP (24.62 months) and best survival rates.
• Non-castrated T levels (>50 ng/dL) were associated with the worst prognosis and shortest TTP (10.93 months).

Conclusions:

• The traditional 50 ng/dL castration threshold may be too high for advanced prostate cancer patients on ADT.
• A threshold of 10 ng/dL appears more critical for evaluating tumor progression and patient prognosis.
• Lowering the castration threshold to 10 ng/dL could refine treatment strategies and improve outcomes.