title: Failure to maintain a suppressed level of serum testosterone during long-acting depot luteinizing hormone-releasing hormone agonist therapy in patients with advanced prostate cancer.
abstract: OBJECTIVE
  It was the aim of this study to analyze the failure rates in achieving or maintaining castrate levels of serum testosterone in patients with advanced prostate cancer treated with the 3-month luteinizing hormone-releasing hormone agonist (LH-RH) therapy.
  
  
  METHODS
  Total serum testosterone was determined in 234 patients with prostate cancer in a cross-sectional study. A subset of 90 patients submitted to radical prostatectomy was used as the control group (group 1), and 144 patients with advanced prostate cancer under androgen suppression therapy were included in the study group (groups 2 and 3). The study group was divided into 93 patients (group 2) treated with 50 mg daily bicalutamide and LH-RH agonist (maximal androgen blockade, MAB) and 51 patients treated with the LH-RH agonist alone (group 3). Median follow-up after androgen suppression was 42 months. The castrate testosterone level was defined below 50 ng/dl.
  
  
  RESULTS
  The mean serum testosterone level was 29.1 ng/dl in patients undergoing MAB (group 2) and 29.5 ng/dl in patients treated with the LH-RH agonist (group 3; p > 0.05). In group 1, the mean serum testosterone was 445.2 ng/dl (p < 0.0001). The rate of patients with a serum testosterone level higher than 50 ng/dl was 10.9% in patients undergoing androgen suppression, 10% in patients with MAB treatment and 12.5% in those with LH-RH agonist therapy (p > 0.05). In group 1, 98.9% of the patients had a serum testosterone level higher than 50 ng/dl.
  
  
  CONCLUSIONS
  A small but clinically significant rate of patients under 3-month LH-RH agonist therapy fail to achieve or maintain castrate testosterone serum levels. This finding supports the need of monitoring testicular response during LH-RH agonist therapy.
authors.affiliation: Department of Urology, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Morote
authors.forename: Salvador
authors.initials: S
authors.lastname: Esquena
authors.forename: José M
authors.initials: JM
authors.lastname: Abascal
authors.forename: Enrique
authors.initials: E
authors.lastname: Trilla
authors.forename: Luis
authors.initials: L
authors.lastname: Cecchini
authors.forename: Carles X
authors.initials: CX
authors.lastname: Raventós
authors.forename: Roberto
authors.initials: R
authors.lastname: Catalán
authors.forename: Jaume
authors.initials: J
authors.lastname: Reventós
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D000813:Anilides / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003692:Delayed-Action Preparations / Q000627:therapeutic use; D018450:Disease Progression; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D011471:Prostatic Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D013739:Testosterone / Q000097:blood*; D014105:Tosyl Compounds; D017211:Treatment Failure
chemical_list: D000726:Androgen Antagonists; D000813:Anilides; D003692:Delayed-Action Preparations; D009570:Nitriles; D014105:Tosyl Compounds; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; C053541:bicalutamide