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Vol. 40. Issue 8.
Pages 477-484 (October 2016)
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Vol. 40. Issue 8.
Pages 477-484 (October 2016)
Review article
DOI: 10.1016/j.acuroe.2016.07.002
Measurement of serum testosterone during androgenic suppression in patients with prostate cancer: A systematic review
Determinación de la testosterona sérica durante la supresión androgénica en pacientes con cáncer de próstata: una revisión sistemática
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J. Morote, L. Regis
Corresponding author
lucasregis@gmail.com

Corresponding author.
, A. Celma, J. Planas
Servicio de Urología, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Table 1. Characteristics of the studies that have analyzed the influence of ST levels in the evolution of patients with PC undergoing AS.
Abstract
Introduction

Clinical practice guidelines recommend measuring serum testosterone (ST) during androgenic suppression (AS) to assess its efficacy and define castration resistance (CR). The objectives of this systematic review were to assess the level of scientific evidence that justify checking ST levels during AS, when to perform it and for what purpose.

Material and methods

We performed a search in PubMed with the following mesh terms: androgen suppression, testosterone, and prostate cancer. The search was narrowed to original articles published in English.

Results

We found 8 publications that analyzed the clinical impact of ST concentrations during AS. In all of the series, ST was measured using chemiluminescent assays. However, only indirect methods based on liquid or gas chromatography for its extraction and subsequent quantification using mass spectrometry are recommended, especially for measuring low levels. The endpoints were specific survival and CR-free survival. Six studies were retrospective. The series were not uniform in terms of clinical stage, types of AS and ST assessment methods. In general, low ST levels (<20ng/dl or <32ng/dl) were related to longer CR-free survival. The measurements were performed every 3 or 6 months. Four studies confirmed the beneficial effect of adding bicalutamide when detecting microelevations above 50ng/dl.

Conclusions

The level of scientific evidence justifying the measurement of ST during AS is low, and the methods employed for quantifying ST levels are inadequate. However, we consider it useful to check ST levels during AS, and there appears to be an association between low ST levels and better disease outcomes. In the event of microelevations above 50ng/dl, we recommend the administration of bicalutamide.

Keywords:
Prostate cancer
Androgenic suppression
Testosterone
Resumen
Introducción

Las guías de práctica clínica recomiendan determinar testosterona sérica (TS) durante la supresión androgénica (SA) para evaluar su eficacia y definir la resistencia a la castración (RC). Los objetivos de esta revisión sistemática han sido evaluar la evidencia científica que puede justificar su control durante la SA, cuándo hacerlo y para qué.

Material y métodos

Se realizó un búsqueda en PubMed con los términos MeSH: androgen suppression, testosterone, and prostate cancer. Se acotó la búsqueda a artículos originales publicados en inglés.

Resultados

Se encontraron 8 publicaciones que analizaron el impacto clínico de la concentración de TS durante la SA. En todas las series se determinó la TS mediante ensayos quimioluminiscentes. Sin embargo, solamente métodos indirectos basados en cromatografía líquida o gaseosa para su extracción y posterior cuantificación mediante espectrometría de masas son recomendados, especialmente para determinar niveles bajos. Los objetivos fueron supervivencia específica y libre de RC. Seis estudios fueron retrospectivos. Las series no fueron uniformes respecto al estadio clínico, tipos de SA y forma de valorar la TS. En general, niveles de bajos de TS (<20ng/dl o <32ng/dl) se relacionaron con mayor supervivencia libre de RC. Las determinaciones se realizaron cada 3 o 6 meses. En 4 estudios se confirmó el efecto beneficioso de añadir bicalutamida cuando se detectaron microelevaciones por encima de 50ng/dl.

Conclusiones

El nivel de evidencia científica que justifica la determinación de TS durante la SA es bajo, y los métodos utilizados para su cuantificación inapropiados. A pesar de ello, se considera útil controlar nos niveles de TS durante la SA, y parece existir una asociación entre niveles bajos y mejor evolución de la enfermedad. En caso de microelevaciones por encima de 50ng/dl se recomienda la administración de bicalutamida.

Palabras clave:
Cáncer de próstata
Supresión androgénica
Testosterona

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