Background:

We seek to determine if testosterone levels below the accepted castration threshold (50 ng/dL) have an impact on time to progression to castrate-resistant prostate cancer (CRPC).

Methods:

This is a prospective cohort series of patients undergoing androgen deprivation therapy (ADT) with luteinizing hormone-releasing hormone agonist or antagonist at a tertiary centre from 2006 to 2011. Serum testosterone level was assessed every 3 months. Patients with any testosterone> 50 ng/dL were excluded. Patients were stratified into groups based on those achieving mean testosterone levels< 20 ng/dL and< 32 ng/dL. Progression to CRPC was assessed with the Kaplan-Meier method and compared with the log-rank test.

Results:

A total of 32 patients were included in this study. Mean patient follow-up was 25.7 months. Patients with a 9-month serum testosterone< 32 ng/dL had a significantly increased time to CRPC compared to patients with testosterone 32 to 50 ng/dL (p= 0.001, median progression-free survival (PFS) 33.1 months [< 32 ng/dL] vs. 12.5 months [> 32 ng/dL]). Patients with first year mean testosterone< 32 ng/dL also had a significantly increased time to CRPC compared to 32 to 50 ng/dL (p= 0.05, median PFS 33.1 months [< 32 ng/dL] vs. 12.5 months [32–50 ng/dL]). A testosterone< 20 ng/dL compared to 20 to 50 ng/dL did not significantly predict with time to CRPC.

Conclusion:

This study supports a lower testosterone threshold to define optimal medical castration (T< 32 ng/dL) than the previously accepted standard of 50 ng/dL. Testosterone levels during ADT serve as an early predictor of disease progression and thus should be measured in conjunction with prostate-specific antigen.