Prognostic value of true castration levels of testosterone in patients with hormone-sensitive prostate cancer

Grickevich A.A., Mishugin S.V., Kazanceva M.V., Teplov A.A., Medvedev V.L., Rusakov I.G.

Current guidelines recommend to maintain the target level of testosterone (T) during hormone therapy not higher than 1.73 nmol/l (50 ng/dl). However, in the majority of patients who undergo surgical castration (SC), concentration of T reaches < 0,694 nmol/l (< 20 ng/dl), but these levels are rarely attainable in patients on analogues of luteinizing hormone-releasing hormone (LHRH). It is likely that the hormone therapy should aim at reduction of T in plasma lower than it is being recommended currently. The study was conducted to explore the prognostic role of serum T during androgen deprivation therapy (ADT). The influence of the rising T ("bursts") on the biochemical progression (BP) in long-term care using LHRH was studied in hormone-sensitive prostate cancer (PCA). Could it be so that the castration level of T below 1,73 nmol/l is a parameter of efficacy of therapy? The relationship between the level of T at ADT and dynamics of prostate specific antigen (PSA) was studied. A comparative evaluation of clinical effects of treatment with degarelix and surgical castration (HC) as the second line of hormonal therapy (HT) in case of BP was also under investigation. Multivariate analysis determined the prognostic factors affecting the decline in PSA levels. The influence of the T dynamics on the follicle stimulating hormone (FSH) and PSA, age, degree of tumor differentiation, the period of ADT to PSA"flash" ТNМ stage of the tumor was studied. We have showed the importance of reducing FSH during therapy with antagonist of LHRH on the dynamics of PSA. It was shown that in both groups with increasing PSA 38% of patients had elevated levels of T, more than 1,736 nmol/L. T-level more than 2.08 nmol/l (50 ng/DL) was diagnosed in 12.5% of patients in the surgical castration group and in 20% in degarelix group. True castration levels of < 0,694 nmol/l (20 ng/DL) in these groups were detected in 15% of patients on degarelix and in 19% of patients with surgical castration (p< 0.05). 

Authors declare lack of the possible conflicts of interests. 

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androgen deprivation therapy, Degarelix, LHRH antagonists, hormone-sensitive prostate cancer, follicle stimulating hormone, testosterone