9a09ca3e96a3c952d367a6cc8bc1ac76 cancers-15-03479.pdf f46e06c11d2c9ccbc7527202e05227e025839271 cancers-15-03479.pdf 9e07a66aa902d5e485b4aec7a74502c98ab0161f96e3d934644121156cb9350a cancers-15-03479.pdf Title: Methods for Evaluating the Efficacy of Medical Castration: A Systematic Review Subject: Measuring serum testosterone determination during medical castration is recommended by prostate cancer (PCa) guidelines to assess its efficacy and define castration resistance. It has been suggested that other biochemical compounds, such as free testosterone or luteinising hormone (LH), could also assess castration efficacy. We aimed to analyse the current evidence for serum biochemical compounds that could be appropriate candidates for evaluating medical castration efficacy. A systematic review was conducted after two investigators independently searched the literature in the PubMed, Cochrane Library, and EMBASE databases published between January 1980 and February 2023. Their searches used the medical subject headings ‘prostatic neoplasms’, ‘testosterone and androgen antagonists’, ‘gonadotropin-releasing hormone/analogues and derivatives’, ‘free testosterone’, and ‘luteinising hormone’. Studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and their eligibility was based on the Participants, Intervention, Comparator, and Outcome strategy. The search was limited to original articles published in English. Among the 6599 initially identified titles, 15 original studies analysing the clinical impact of serum testosterone levels in PCa patients undergoing androgen deprivation therapy (ADT) were selected for evidence acquisition. The risk of bias in individual studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. All selected studies used immunoassays to measure serum testosterone, although only methods based on liquid or gas chromatography and mass spectrometry are recommended to measure low testosterone concentrations. The reported series were not uniform in clinical stage, ADT types, and the time or number of serum testosterone measurements. Only some studies found low serum testosterone levels (<20 or <32 ng/dL) associated with greater survival free of biochemical progression and castration resistance. We conclude that little current evidence justifies the measurement of serum testosterone during ADT using no appropriate methods. No reported longitudinal studies have examined the clinical impact of serum testosterone measured using liquid chromatography with tandem mass spectrometry (LC-MSMS), free testosterone, or LH in PCa patients undergoing medical castration. We conclude that well-designed longitudinal studies examining the clinical impact of serum testosterone measured with LC-MSMS, serum-free testosterone, and LH on biochemical progression and castration resistance in PCa patients undergoing neo-adjuvant castration in radiation therapy or continuous castration are needed. Keywords: prostate cancer; androgen deprivation therapy; serum testosterone; free testosterone; luteinising hormone Author: Adriana Aguilar, Jacques Planas, Enrique Trilla and Juan Morote Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Mon Jul 3 16:09:21 2023 CEST ModDate: Mon Jul 3 16:11:11 2023 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 731669 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- HCRKXL+VnURWPalladioL Type 1 Custom yes yes no 10 0 RAFXAN+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 HTOZWO+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 NTWMBR+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 43 0 EXRFHO+CMSY10 Type 1 Builtin yes yes no 68 0 DJJPJF+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 75 0 DJJPJG+PalatinoLinotype CID TrueType Identity-H yes yes yes 78 0 DJJPJH+PalatinoLinotype TrueType WinAnsi yes yes no 84 0 DJJPJJ+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 87 0 DJJPJF+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 96 0 DJJPJG+PalatinoLinotype CID TrueType Identity-H yes yes yes 99 0 DJJPJH+PalatinoLinotype TrueType WinAnsi yes yes no 105 0 DJJPJJ+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 108 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-09-26 04:03:20 CEST RepresentationInformation: cancers-15-03479.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-09-25 16:13:04 CEST Size: 731669 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 398 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Evidence Acquisition Destination: section.2 Item: Title: Evidence Synthesis Destination: section.3 Children: Item: Title: Serum Total Testosterone Measurement Destination: subsection.3.1 Children: Item: Title: Localised and Locally Advanced PCa Destination: subsubsection.3.1.1 Item: Title: Metastatic PCa Destination: subsubsection.3.1.2 Item: Title: Localised, Locally Advanced and Metastatic PCa Destination: subsubsection.3.1.3 Item: Title: Serum-Free Testosterone Measurement Destination: subsection.3.2 Item: Title: Serum LH Measurement Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Methods for Evaluating the Efficacy of Medical Castration: A Systematic Review Author: Adriana Aguilar, Jacques Planas, Enrique Trilla and Juan Morote Subject: Measuring serum testosterone determination during medical castration is recommended by prostate cancer (PCa) guidelines to assess its efficacy and define castration resistance. It has been suggested that other biochemical compounds, such as free testosterone or luteinising hormone (LH), could also assess castration efficacy. We aimed to analyse the current evidence for serum biochemical compounds that could be appropriate candidates for evaluating medical castration efficacy. A systematic review was conducted after two investigators independently searched the literature in the PubMed, Cochrane Library, and EMBASE databases published between January 1980 and February 2023. Their searches used the medical subject headings ‘prostatic neoplasms’, ‘testosterone and androgen antagonists’, ‘gonadotropin-releasing hormone/analogues and derivatives’, ‘free testosterone’, and ‘luteinising hormone’. Studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, and their eligibility was based on the Participants, Intervention, Comparator, and Outcome strategy. The search was limited to original articles published in English. Among the 6599 initially identified titles, 15 original studies analysing the clinical impact of serum testosterone levels in PCa patients undergoing androgen deprivation therapy (ADT) were selected for evidence acquisition. The risk of bias in individual studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. All selected studies used immunoassays to measure serum testosterone, although only methods based on liquid or gas chromatography and mass spectrometry are recommended to measure low testosterone concentrations. The reported series were not uniform in clinical stage, ADT types, and the time or number of serum testosterone measurements. Only some studies found low serum testosterone levels (<20 or <32 ng/dL) associated with greater survival free of biochemical progression and castration resistance. We conclude that little current evidence justifies the measurement of serum testosterone during ADT using no appropriate methods. No reported longitudinal studies have examined the clinical impact of serum testosterone measured using liquid chromatography with tandem mass spectrometry (LC-MSMS), free testosterone, or LH in PCa patients undergoing medical castration. We conclude that well-designed longitudinal studies examining the clinical impact of serum testosterone measured with LC-MSMS, serum-free testosterone, and LH on biochemical progression and castration resistance in PCa patients undergoing neo-adjuvant castration in radiation therapy or continuous castration are needed. 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