title: Effects of serum testosterone levels after 6 months of androgen deprivation therapy on the outcome of patients with prostate cancer.
abstract: BACKGROUND
  Controversy exists about whether testosterone serum levels at a cutoff point of < 50 ng/dL during luteinizing hormone-releasing hormone analogue (LHRHA) treatment are related to the outcome of patients with prostate cancer. We assessed the relationship between serum testosterone levels after 6 months of LHRHA therapy and disease outcome in a consecutive series of patients with prostate cancer.
  
  
  METHODS
  Serum testosterone levels were measured prospectively in a cohort of patients given LHRHA for 6 months. End points were time to progression (TTP) and overall survival (OS).
  
  
  RESULTS
  The study population was 153 patients: 54 with metastatic disease and 99 with biochemical failure. In multivariate analysis, adjustment for age, baseline serum prostatic specific antigen (PSA) levels, Gleason score, and disease stage, testosterone levels < 50 ng/dL failed to be associated with TTP and OS. A cutoff of < 20 ng/dL was associated with a nonsignificant lower risk of progression (adjusted hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.30-1.15; P = .12) and a significant lower risk of death (adjusted HR, 0.19; 95% CI, 0.04-0.76; P = .02). Only 25 patients attained serum testosterone levels < 20 ng/dL. Using a receiver operating characteristic curve (ROC), we found that a testosterone value of 30 ng/dL offered the best overall sensitivity and specificity for prediction of death. Serum testosterone levels < 30 ng/mL were associated with a significantly lower risk of death (adjusted HR, 0.45; 95% CI, 0.22-0.94; P = .034.
  
  
  CONCLUSIONS
  Serum testosterone levels lower than the currently adopted cutoff of 50 ng/dL have a prognostic role in patients with prostate cancer receiving LHRHA and are a promising surrogate parameter of LHRHA efficacy.
authors.affiliation: Medical Oncology, Department of Oncology, Università degli Studi di Torino, Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Bertaglia
authors.forename: Marcello
authors.initials: M
authors.lastname: Tucci
authors.forename: Cristian
authors.initials: C
authors.lastname: Fiori
authors.forename: Emiliano
authors.initials: E
authors.lastname: Aroasio
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Poggio
authors.forename: Consuelo
authors.initials: C
authors.lastname: Buttigliero
authors.forename: Susanna
authors.initials: S
authors.lastname: Grande
authors.forename: Andrea
authors.initials: A
authors.lastname: Saini
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Alfredo
authors.initials: A
authors.lastname: Berruti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D013534:Survival; D013739:Testosterone / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D015415:Biomarkers; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone
keywords: Hormonal therapy; Prognosis; Prostate cancer; Testosterone