LHRH agonist therapy than with surgical castration: new insights attained by mass spectrometry

PURPOSE. Androgen deprivation therapy by bilateral orchiectomy (surgical castration) or luteinizing hormone-releasing hormone (LHRH) agonist therapy (medical castration) is recommended for advanced or metastatic prostate cancer. Both methods aim at reducing serum testosterone concentrations to a castrate level which is currently defined as less than 50 ng/dL. The results of previous studies are based on testosterone immunoassays that have insufficient accuracy in the low range. In this study we reevaluated serum testosterone concentrations in men on androgen deprivation therapy using isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS), an accurate method of measuring testosterone in the castrate range. MATERIALS AND METHODS. Subjects underwent surgical castration (34) or received a LHRH agonist (32). Serum samples were obtained more than 3 months after surgery or initiation of LHRH agonist therapy. Testosterone levels were determined using ID-LC-MS/MS. Dihydroepiandrosterone sulfate, androstenedione, sex hormone-binding globulin and inhibin B levels were determined. RESULTS. All subjects had serum testosterone values less than 50 ng/dL and 97% had testosterone concentrations less than 20 ng/dL. Medically castrated men had significantly lower testosterone levels (median 4.0 ng/dL, range less than 2.9 to 20.2) than those surgically castrated (median 9.2 ng/dL, range less than 2.9 to 28.8, p < 0.001). No difference was found in dehydroepiandrosterone sulfate, androstenedione, and sex hormone-binding globulin levels between the groups, whereas inhibin B levels were significantly higher in the LHRH agonist treated group. CONCLUSION. Using an accurate technique for testosterone measurement, subjects on LHRH agonist therapy had significantly lower testosterone concentrations than men who underwent surgical castration. The clinical relevance of these findings remains to be determined.