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Testosterone-guided ADT for prostate cancer Tsutomu Nishiyama and Tatsuhiko Hoshii Luteinizing-hormone-releasing hormone (LHRH) agonists as androgen deprivation therapy (ADT) for men with advanced prostate cancer are usually administered indefinitely on a fixed schedule. However, using testosterone level to guide ADT in these patients could lead to reductions in cost and some symptomatic improvements. Refers to Niraula, S. et al. Study of testosterone-guided androgen deprivation therapy in management of prostate cancer. Prostate 76, 235–242 (2016)
In men with advanced prostate cancer, luteinizing-hormone-releasing hormone (LHRH) agonists as androgen deprivation therapy (ADT) are typically administered at fixed intervals and continued indefinitely. In a new paper, Niraula et al.1 report that scheduling ADT with LHRH agonist injections on the basis of serum testosterone level reduces exposure to LHRH agonists, with substantial cost savings and improvement in some symptoms caused by ADT. The authors suggest that testosterone-guided ADT should
be considered as an alternative to the usual fixed-schedule treatment. As testosterone promotes growth of many prostate cancers, reducing circulating testos terone to very low (castration) levels is often the treatment goal in the management of men with advanced prostate cancer. The optimum serum castration levels to be achieved with ADT are still under debate. The different units of measurement of testosterone used in clinical practice — ng/dl, ng/ml, and nmol/l — lead to confusion. Errors
luchschen/iStock/Thinkstock
NATURE REVIEWS | UROLOGY
in numerical notation are present in the article written by Niraula and co‑workers. Unification, using the International System of Units (SI) for describing the unit of measure of testosterone in nmol/l, is necessary and was used in the article. In 2008, the Centers for Disease Control and Prevention, in collaboration with the clinical, laboratory, and research communities, initiated efforts to standardize testosterone measurement in an effort to address the problems in comparability of measured testosterone levels and assay performance, particularly at low serum levels. Collaborative initiatives are underway to develop universally standardized assays2. The results of these activities might result in more accurate measurement of castration testosterone levels and in the incorporation of testosterone level measurement for the monitoring of ADT. The standardization of serum testosterone level measurement would enable comparison across clinical trials as well as recommendations for optimal values after ADT. At present, the lower limit of quantitation of testosterone using a liquid chromatography tandem mass s pectrometry assay is
Testosterone-guided ADT for prostate cancer Tsutomu Nishiyama and Tatsuhiko Hoshii Luteinizing-hormone-releasing hormone (LHRH) agonists as androgen deprivation therapy (ADT) for men with advanced prostate cancer are usually administered indefinitely on a fixed schedule. However, using testosterone level to guide ADT in these patients could lead to reductions in cost and some symptomatic improvements. Refers to Niraula, S. et al. Study of testosterone-guided androgen deprivation therapy in management of prostate cancer. Prostate 76, 235–242 (2016)
In men with advanced prostate cancer, luteinizing-hormone-releasing hormone (LHRH) agonists as androgen deprivation therapy (ADT) are typically administered at fixed intervals and continued indefinitely. In a new paper, Niraula et al.1 report that scheduling ADT with LHRH agonist injections on the basis of serum testosterone level reduces exposure to LHRH agonists, with substantial cost savings and improvement in some symptoms caused by ADT. The authors suggest that testosterone-guided ADT should
be considered as an alternative to the usual fixed-schedule treatment. As testosterone promotes growth of many prostate cancers, reducing circulating testos terone to very low (castration) levels is often the treatment goal in the management of men with advanced prostate cancer. The optimum serum castration levels to be achieved with ADT are still under debate. The different units of measurement of testosterone used in clinical practice — ng/dl, ng/ml, and nmol/l — lead to confusion. Errors
luchschen/iStock/Thinkstock
NATURE REVIEWS | UROLOGY
in numerical notation are present in the article written by Niraula and co‑workers. Unification, using the International System of Units (SI) for describing the unit of measure of testosterone in nmol/l, is necessary and was used in the article. In 2008, the Centers for Disease Control and Prevention, in collaboration with the clinical, laboratory, and research communities, initiated efforts to standardize testosterone measurement in an effort to address the problems in comparability of measured testosterone levels and assay performance, particularly at low serum levels. Collaborative initiatives are underway to develop universally standardized assays2. The results of these activities might result in more accurate measurement of castration testosterone levels and in the incorporation of testosterone level measurement for the monitoring of ADT. The standardization of serum testosterone level measurement would enable comparison across clinical trials as well as recommendations for optimal values after ADT. At present, the lower limit of quantitation of testosterone using a liquid chromatography tandem mass s pectrometry assay is
