Objective: To analyze the current available evidence of androgen deprivation therapy in hormone-sensitive metastatic prostate cancer, focused on the relevance of suppressing circulating testosterone levels and its prognostic significance. To assess the optimal value of castration levels and PSA reduction under hormone treatment.
Methods: We performed a bibliographic review through automatized search in the Pubmed bibliographic database and Clinical Key. The search strategy included the following terms: "prostate cancer" AND "hormones", "metastatic prostate cancer", "testosterone" AND "prostate cancer", "hormone naive/sensitive" AND "prostate cancer".
Results: Lower testosterone levels are associated with better survival and have prognostic significance. Values below 32-20 ng/dl, in accordance to different reported studies, have been established as optimal castration levels with clinical significance, with impact on cancer specific survival and time to castration resistance. Similarly, low PSA levels after starting hormone therapy have been suggested as a strong predictor of survival and treatment response.
Conclusions: Close monitoring of PSA and testosterone levels is necessary in patients with metastatic prostate cancer during hormone deprivation treatment. Combination of both values allows to predict treatment response and early identification of tumor progression, and to put forward subsequent therapeutic strategies improving survival in this group of patients.