Study of the predictive value of testosterone in androgen deprivation therapy for metastatic hormone-sensitive prostate cancer-the dual clinical research center for western and eastern China.

[OBJECTIVE] This study aims to investigate the association between early testosterone (T) response to androgen deprivation therapy (ADT) and clinical outcomes in metastatic hormone-sensitive prostate cancer (mHSPC).

[METHODS] This retrospective cohort study analyzed 366 mHSPC patients treated at The People's Hospital Bozhou and The First Affiliated Hospital of Xinjiang Medical University. The participants were stratified by 1-month testosterone response: response group (T < 50 ng/dL) and non-response group (T > 50 ng/dL). The response group was further subdivided into ultra-low (T < 20 ng/dL) and low (20-50 ng/dL) response groups. Comparative analyses of baseline characteristics, progression to metastatic castration-resistant prostate cancer (mCRPC), and survival outcomes were carried out.

[RESULTS] No significant intergroup differences were observed in Gleason score, tumor stage, prostate volume, initial PSA, PSA density, perineural invasion, visceral metastasis, or hazard level (all > 0.05). However, the T non-response group exhibited a higher tumor load prevalence (76.77% vs. 60.10%, = 0.004). The T non-response group demonstrated shorter mCRPC progression time (13.38 ± 8.88 vs. 20.40 ± 11.91 months, < 0.001), though no difference emerged between the T ultra-low and low response subgroups (20.59 ± 11.91 vs. 20.86 ± 12.19 months, = 0.876). Survival analysis revealed superior 3-year survival in T responders ( = 0.024), with T ultra-low responders showing significant advantages in both overall survival ( = 0.010) and 3-year survival ( = 0.001) compared to T low responders.

[CONCLUSION] Ultra-low T levels (<20 ng/dL) after 1-month ADT can be used as a reference standard for predicting survival outcomes and may guide treatment optimization in mHSPC.