Testosterone monitoring and supplementation in patients with intermediate- or high-risk prostate cancer treated with 6-36 months of androgen deprivation therapy and radiotherapy: a systematic literature review.
Vérane Achard, Almudena Zapatero, Amar U Kishan et al.
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In 30 seconds
This systematic literature review examined testosterone monitoring, recovery, and replacement therapy in patients with intermediate- or high-risk localised prostate cancer treated with androgen deprivation therapy (ADT) and curative-intent radiotherapy. It included 29 studies. Baseline testosterone was not associated with oncological outcomes, while on-treatment suppression to < 20 ng/dL (<0.7 nmol/L), rather than the conventional 50 ng/dL (<1.7 nmol/L) threshold, was associated with improved oncologic outcomes. Testosterone recovery varied with ADT duration and patient and treatment factors. Evidence on testosterone replacement after curative treatment was very limited, particularly for high-risk patients treated with ADT and radiotherapy.
Key findings
- Baseline testosterone was not associated with oncological outcomes but strongly predicted testosterone recovery after treatment.
- On-treatment testosterone < 20 ng/dL (<0.7 nmol/L), rather than the conventional 50 ng/dL (<1.7 nmol/L) threshold, was associated with improved oncologic outcomes.
- Non-castrate testosterone levels were typically reached within 6-15 months; full eugonadal recovery often took years and remained incomplete in a substantial proportion.
- Limited observational evidence suggested testosterone replacement after curative treatment did not increase recurrence risk, but evidence in high-risk patients receiving ADT and radiotherapy was sparse.
Why it matters
Testosterone levels may help characterise treatment response and anticipate recovery after ADT, which can be prolonged or incomplete. The review also highlights that evidence about testosterone replacement in this setting is insufficient for confident conclusions, especially for high-risk disease. These uncertainties matter when interpreting testosterone results and discussing persistent hypogonadal symptoms after curative treatment.
What to keep in mind
Evidence for testosterone replacement was very limited and observational, with sparse data in high-risk patients treated with ADT and radiotherapy.