Reasons for testosterone measurement in prostate cancer

Testosterone measurement in prostate cancer patients has more than 40 years history [2]. Confirmation of castrate testosterone level is necessary before identifying prostate cancer as castration resistant. Castrate states are at present defined as serum testosterone level below 20 ng/dl (=0.69 nmol/l) or below 50 ng/dl (=1.73 nmol/l) [3], but it was not always this way and different testosterone measurement methods have important implications.

Need for controlling quality of chemical castration treatment of prostate cancer steams from reports of up to 15% castration failures [4,5]. This means LHRH treated patients may not reach castration levels of testosterone due to different reasons [6], not only non-compliance, application failures, but also other reasons, for example problems with depot formulation resorption due to granuloma formation on injection site [7] or may simply need more frequent dosages [8].

Further reason for testosterone measurements in prostate cancer patients lies in reports of correlation between success of castration and time to PSA progression: better castration

(lower testosterone value) gives longer time to progression [9,10]. Therefore hormonal treatment of prostate cancer should not be followed with PSA measurement only (as indirect indication of treatment success), but also with testosterone measurement [11].

Before any treatment, at diagnosis, serum testosterone value is predictor of disease aggressiveness - lower testosterone values are related to less differentiated cancer and worse prognosis [12]. For all stated reasons, measurement of serum testosterone is important for clinicians who treat prostate cancer patients.

After long term of androgen suppression with LHRH (GnRH) analogues, sometimes testosterone levels do not recover after stopping treatment (which may be due to permanent dysfunction of Lydig cells), therefore application of LHRH drugs may be stopped in selected patients [13]. However, this should be confirmed and followed with testosterone measurement.

But testosterone measurements are not important only for urologists, who, apart from main reason - decisions related to prostate cancer management, use it for example also for aging male symptomatology and evaluation of patients with erectile dysfunction. Also other medical specialties, like endocrinology, pediatrics, gynecology or oncology use testosterone measurements for their conditions, like diagnosing and monitoring hyper- or hypo- andro-genic disorders in women, like polycystic ovary syndrome, alopecia, acne, hirsutism or hy-poactive sexual desire disorder; androgen secreting neoplasms; congenital syndromes with ambiguous genitalia... Pediatrics and endocrinology were in the past probably most frequent users of testosterone assays, but nowadays most laboratories receive most testosterone requests from urologists.

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