[Chinese expert consensus on prostate cancer testosterone management (2026 edition)]

The incidence of prostate cancer in China is increasing year by year. Data from 2022 indicate that its incidence ranks sixth among male malignant tumors, with a high proportion of advanced-stage patients and high mortality rate among new cases each year, leading to a continuously increasing disease burden. Androgen deprivation therapy (ADT) has been the cornerstone of treatment for advanced prostate cancer since its establishment in 1941. Whether as monotherapy or in combination with novel endocrine therapeutic agents, ADT-based regimens should be maintained throughout the entire treatment course of advanced prostate cancer. Testosterone is a critical biomarker for monitoring the efficacy of ADT, and testosterone management is of great significance in achieving refined ADT goals and improving patient prognosis. This consensus recommends a testosterone level of >50 ng/dL as the castration standard. On this basis, deep testosterone suppression, defined as reducing testosterone levels to below 20 ng/dL, may serve as a reference indicator for improving patient prognosis. Regarding testosterone measurement, radioimmunoassay (RIA), chemiluminescence immunoassay (CLIA), and liquid chromatography-tandem mass spectrometry (LC-MS/MS) are all available methods. Considering the balance between cost and efficiency, this consensus recommends that a stepwise testing approach for testosterone monitoring be adopted if conditions permit, to improve sensitivity, accuracy, and stability. Testosterone monitoring should be performed throughout the entire process of prostate cancer diagnostic and treatment. Baseline level should be measured before ADT initiation; monitoring should be performed monthly for the first 6 months of treatment; after disease stabilization, every 3 months for the first 3 years, and every 6 months thereafter. Patients in critical phases such as neoadjuvant therapy, initiation of adjuvant therapy, biochemical recurrence, and metastatic castration-sensitive prostate cancer require particular attention to testosterone surveillance. In the whole-process management of prostate cancer diagnosis and treatment, attention should be paid to testosterone monitoring alongside prostate-specific antigen (PSA) surveillance. PSA cannot directly replace testosterone levels in evaluating ADT efficacy, as there is no linear correlation between the two parameters. Maintaining an appropriate frequency of testosterone testing and using the results of both tests to guide personalized therapeutic decisions can facilitate timely detection of testosterone escape and confirmation of castration-resistant status, provide evidence for treatment switching, and ultimately improve patient survival benefits and quality of life.