Beyond castration: defining maximal testosterone control in advanced prostate cancer.

Objective: This study aimed to investigate the correlation between the minimum testosterone (T) level achieved during androgen deprivation therapy (ADT) for advanced prostate cancer and progression and prognosis. And to establish the new recommended threshold for defining castration-level testosterone. Methods: A retrospective analysis was conducted on 425 patients with advanced prostate cancer undergoing ADT. Patients were stratified into three groups based on their lowest testosterone level: castration low<10 ng/dL, castration 10-50 ng/dL, Non-castrated >50 ng/dL. To further explore subgroup progression and survival differences in low castrated testosterone levels, those castrated low testosterone levels were divided into two groups, castration ultra-low 5-10 ng/dL and castration extreme low<5ng/dL. Additionally, a small cohort (N = 29) of surgically castrated patients was included for subgroup analysis. Correlations between the minimum testosterone level and outcomes, time to progression (TTP) and overall survival (OS). Results: Significant differences in TTP were observed among the three groups ( Conclusion: Challenging the traditional castration standard, this study identifies 10 ng/dL (versus 50 ng/dL) as the critical testosterone threshold for evaluating tumor progression and prognosis in advanced prostate cancer patients on ADT.