Carry out ketone reduction to the end - standardized management of testosterone in prostate cancer

*For reference only for medical professionals Prostate cancer is one of the most common malignant tumors of the male genitourinary system, and its incidence ranks second in male malignant tumors, second only to lung cancer
.

Androgen deprivation therapy (ADT) is one of the basic treatments for prostate cancer, and testosterone (T) is a key indicator for evaluating the efficacy of ADT1
.

Therefore, the standardized management of testosterone during ADT is of great significance
.

01 Serum testosterone detection method 02 Authoritative guideline and research on testosterone cutoff after ADT treatment The lower testosterone cutoff value after ADT treatment has been continuously explored
.

03Guide the treatment strategy according to testosterone levels During ADT treatment, testosterone levels reflect the effect of treatment, while serum prostate-specific antigen (PSA) concentrations reflect disease control
.

At best, both testosterone and PSA remain low (T ≤ 20ng/dl and PSA ≤ 2ng/ml), and reassessment and changes in treatment strategy are warranted if one of these begins to rise
.

In ADT therapy, monitoring testosterone levels to guide ADT administration was associated with a 35% lower risk of treatment failure than day-by-date administration
.

04 Standardized long-term monitoring and management of testosterone levels05 Clinical significance of testosterone management Clinical studies have shown that T≤20 ng/dl or lower after ADT treatment, that is, deep ketone reduction (DTR), can bring the following significant benefits: 1 .
Significantly reduce the biochemical recurrence and metastasis rate of prostate cancer, with higher progression-free survival rate; 2.
Significantly prolong the time of progression to castration-resistant prostate cancer (CRPC), even after progression to CRPC, the survival time is longer; 3.
Significantly delays disease progression and improves overall survival in patients with prostate cancer 1
.

At present, domestic doctors and patients' awareness and clinical application of testosterone management need to be improved
.

The attention of clinicians and patients to the standardized management of testosterone should be enhanced through systematic propaganda and patient education
.

Optimize testosterone management and allow patients to understand clinical measures of treatment beyond PSA
.

Establish a scientific testosterone management model to further improve the overall survival of prostate cancer patients in China 1
.

Tips: Little knowledge of testosterone Testosterone is the main male androgen, a steroid hormone
.

(1) Testosterone production: 95% is synthesized by Leydig cells, and a small amount is synthesized in the adrenal cortex
.

(2) Existence form: ① Most of them exist in combined form: 44%-60% are combined with sex hormone-binding protein; 38%-54% are combined with albumin and other proteins)
.

②1%~3% exist in free form (free testosterone is the main substance to exert biological activity)
.

(3) Physiological function: maintain muscle volume and strength, bone density and strength, and maintain normal libido and sexual function 1
.

References: [1].
Urology Branch of Chinese Medical Association, Urology and Male Genital Tumor Professional Committee of China Anti-Cancer Association, Urology Branch of Chinese Medical Doctor Association.
Chinese Expert Consensus on Testosterone Management in Prostate Cancer (2021 Edition).
Chinese Urology Department Journal.
2021, 42 (4): 241-245.
[2].
Yuan Congying.
Establishment of a solid-phase radioimmunoassay method for testosterone.
Marker Immunoassay and Clinic.
2018,25(5):745-749.
[3] Ji Shimin, Dai Xiuxia, Wu Luling.
Rapid detection of serum testosterone in athletes by Access immunoassay system.
Sports and Science.
2004, 25(2): 69-70.
[4].
Bryant AK, McKay RR, Kader AK, et al.
Subcastrate Testosterone Nadir and Clinical Outcomes in Intermediate- or High-Risk Localized Prostate Cancer.
Int J Radiat Oncol Biol Phys.
2019,103(5):1068-76.
[5].
Dason S, Allard CB, Tong J, et al .
Defining a new testosterone threshold for medical castration: Results from a prospective cohort series.
Can Urol Assoc J.
2013,7(5-6):E263-7.
[6].
Klotz L, O'Callaghan C, Ding K, et al.
Nadir testosterone within first year of androgen- deprivation therapy (ADT) predicts for time to castration-resistant progression:a secondary analysis of the PR-7 trial of intermittent versus continuous ADT.
J Clin Oncol.
2015,33(10):1151-6.
[7].
Urology Branch of Chinese Medical Association, China Prostate Cancer Alliance.
Prostate cancer testosterone Chinese expert consensus on management (2017 edition).
Chinese Journal of Urology.
2017,38(6):401-405.
[8].
Klotz L, Shayegan B, Guillemette C, et al.
Testosterone suppression in the treatment of recurrent or metastatic prostate cancer - A Canadian consensus statement.
Can Urol Assoc J.
2018, 12(2):30-37.
[9].
Cornford P, Bellmunt J, Bolla M, et al.
EAU-ESTRO-SIOG Guidelines on Prostate Cancer.
Part II: Treatment of Relapsing, Metastatic, and Castration-Resistant Prostate Cancer.
Eur Urol.
2017,71(4):630-642.
[10].
Blumberg JM, Kwon EO, Cheetham TC, et al.
Early development of castrate resistance varies with different dosing regimens of luteinizing hormone releasing hormone agonist in primary hormonal therapy for prostate cancer.
Urology.
2011,77(2):412-416.
This material is supported by AstraZeneca and is only for reference by medical and health professionals.
Approval number: CN-80910 Validity period: 2023-6-22