| ObjectiveTo investigate the effect of serum testosterone level on the progression of advanced metastatic prostate cancer during endocrine therapy and its clinical significance.MethodsTo collect the complete clinical data of 164 patients with advanced bone metastatic prostate cancer who were treated in the first affiliated hospital of Zhengzhou University from January 2016 to June 2020 and were followed up continuously,the general situation,clinical manifestations,examination,pathology and follow-up were analyzed retrospectively.All patients were given continuous endocrine therapy,and the maximum androgen blockade,and the end point was castration-resistant prostate cancer.The PSA and serum testosterone levels were monitored during treatment,the patients were divided into 3 groups according to the highest level of serum testosterone,including low testosterone castration(<0.2 ng/mL)of 50 cases,high testosterone castration group(0.2～0.5 ng/mL)43 cases,uncastrated in time group(>0.5 ng/mL)38 cases,analysis in the three groups were compared to the percentage of CRPC,progress for CRPC use time,The association between the highest serum testosterone and the time to progression of CRPC was analyzed using Person correlation analysis.According to the method of castrating,the patients were divided into two groups,including 131 patients in the drug group(drug castrated)and 33 patients in the surgical group(surgical castrated).The percentage of patients with CRPC and the time to progression to CRPC were analyzed and compared between the two groups.ResultThe percentage of CRPC in the low testosterone castration group,the high testosterone castration group and the uncastrated in time group were 44.00%,76.74%and 92.10%,respectively,with statistically significant overall difference(χ2=25.162,P<0.001).The comparison between the low testosterone castration group and the high testosterone castration group was χ2=10.258,P=0.001;χ2=21.897,P<0.001;Comparison between the high testosterone castrated group and the uncastrated in time group:x2=3.533,P=0.060.There was statistically significant difference in the time to progression of CRPC among the 3 groups(F=62.290,P<0.001).The pairwise comparison showed statistically significant differences(P<0.05).The highest level of serum testosterone in 131 patients with advanced bone metastatic prostate cancer was(0.43±0.75)ng/mL,which was negatively correlated with the time to progression of CRPC[(19.42±5.78)months](r=-0.764,P<0.001).According to the methods of castration:the percentages of CRPC in surgical castration group and drug castration group were 63.64%and 68.70%respectively.The progression time of CRPC was(20.33±5.18)months and(19.42±5.78)months respectively.T test was performed,T=0.662,P=0.509,so there was no statistically significant difference in castration methods between the two groups.Conclusion1.Maximum serum testosterone during endocrine therapy was inversely associated with time to progression to CRPC in prostate cancer patients.2.In this study,there was no significant difference in the time taken for patients to progress to CRPC between castration by surgery and castration by drugs.3.The detection of serum testosterone level has important clinical significance in the evaluation of endocrine therapy efficacy,disease progression and prognosis of patients with advanced prostate cancer. |
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