Comas I, Ferrer R, Planas J, Celma A, Regis L, Morote J
Servicio de Bioquímica Clínica, Laboratoris Clínics, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España.
Servicio de Bioquímica Clínica, Laboratoris Clínics, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España.
Actas Urol Esp (Engl Ed). 2018 Mar;42(2):86-93. doi: 10.1016/j.acuro.2017.01.007. Epub 2017 Mar 2.
The clinical practice guidelines recommend measuring serum testosterone in patients with prostate cancer (PC) who undergo castration. The serum testosterone concentration should be <50ng/dL, a level established by using a radioimmunoassay method. The use of chemiluminescent immunoassays (IA) has become widespread, although their metrological characteristics do not seem appropriate for quantifying low testosterone concentrations. The objective of this review is to analyse the methods for quantifying testosterone and to establish whether there is scientific evidence that justifies measuring it in patients with PC who undergo castration, through liquid chromatography attached to a mass spectrometry in tandem (LC-MSMS).
We performed a search in PubMed with the following MeSH terms: measurement, testosterone, androgen suppression and prostate cancer. We selected 12 studies that compared the metrological characteristics of various methods for quantifying serum testosterone compared with MS detection methods.
IAs are standard tools for measuring testosterone levels; however, there is evidence that IAs lack accuracy and precision for quantifying low concentrations. Most chemiluminescent IAs overestimate their concentration, especially below 100ng/dL. The procedures that use LC-MSMS have an adequate lower quantification limit and proper accuracy and precision. We found no specific evidence in patients with PC who underwent castration.
LC-MSMS is the appropriate method for quantifying low serum testosterone concentrations. We need to define the level of castration with this method and the optimal level related to better progression of the disease.
临床实践指南建议对接受去势治疗的前列腺癌（PC）患者测定血清睾酮水平。血清睾酮浓度应<50ng/dL，这一水平是通过放射免疫分析方法确定的。化学发光免疫分析（IA）的应用已很广泛，尽管其计量学特性似乎并不适合定量低睾酮浓度。本综述的目的是分析睾酮定量方法，并确定是否有科学证据支持对接受去势治疗的PC患者通过串联质谱联用液相色谱法（LC-MSMS）测定睾酮。
我们在PubMed中使用以下医学主题词进行检索：测量、睾酮、雄激素抑制和前列腺癌。我们选择了12项研究，这些研究比较了各种血清睾酮定量方法与质谱检测方法的计量学特性。
免疫分析是测量睾酮水平的标准工具；然而，有证据表明免疫分析在定量低浓度时缺乏准确性和精密度。大多数化学发光免疫分析会高估其浓度，尤其是在100ng/dL以下。使用LC-MSMS的方法具有足够低的定量限以及适当的准确性和精密度。我们在接受去势治疗的PC患者中未发现具体证据。
LC-MSMS是定量低血清睾酮浓度的合适方法。我们需要用这种方法确定去势水平以及与疾病更好进展相关的最佳水平。
