Department of Urology, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Biochemistry, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Clin Genitourin Cancer. 2018 Apr;16(2):e491-e496. doi: 10.1016/j.clgc.2017.10.025. Epub 2017 Dec 2.
Serum testosterone measurement is recommended to assess the efficacy of androgen deprivation therapy (ADT) and to diagnose castration resistance in patients with prostate cancer (PCa). Currently, the accepted castrate level of serum testosterone is 50 ng/dL. Liquid chromatography and tandem mass spectrometry (LC MSMS) is the appropriate method to measure testosterone, especially at low levels. However, worldwide, chemiluminescent assays (CLIAs) are used in clinical laboratories, despite their lack of accuracy and reproducibility, because they are automatable, fast, sensitive, and inexpensive.
We compared serum testosterone levels measured using LC MSMS and CLIAs in 126 patients with PCa undergoing luteinizing hormone-releasing hormone (LHRH) agonist therapy.
The median serum testosterone level was 14.0 ng/dL (range, 2.0-67.0 ng/dL) with LC MSMS and 31.9 ng/dL (range, 10.0-91.6 ng/dL) with CLIA (P < .001). The serum testosterone levels, measured using LC MSMS, were < 20 ng/dL in 83 patients (65.9%), 20 to 50 ng/dL in 40 (31.7%), and > 50 ng/dL in 3 patients (2.4%). These ranges were found in 34 (27%), 72 (57.1%), and 20 (15.9%) patients when testosterone was measured using CLIA (P < .001). The castrate level of serum testosterone using LC MSMS and CLIA was 39.8 ng/dL (95% confidence interval [CI], 37.1-43.4 ng/dL) and 66.5 ng/dL (95% CI, 62.3-71.2 ng/dL), respectively.
We found that CLIA overestimated the testosterone levels in PCa patients undergoing LHRH agonist therapy. Thus, the castration level was incorrectly considered inadequate with CLIA in almost 15% of patients. The true castration level of serum testosterone using an appropriate method is < 50 ng/dL.
血清睾酮测量被推荐用于评估雄激素剥夺疗法（ADT）的疗效，并用于诊断前列腺癌（PCa）患者的去势抵抗。目前，公认的血清睾酮去势水平为 50ng/dL。液相色谱-串联质谱（LC-MSMS）是测量睾酮的合适方法，尤其是在低水平时。然而，在全球范围内，尽管化学发光免疫分析（CLIAs）缺乏准确性和重现性，但因其具有自动化、快速、灵敏和廉价的特点，仍被临床实验室所使用。
我们比较了 126 例接受促黄体激素释放激素（LHRH）激动剂治疗的 PCa 患者使用 LC-MSMS 和 CLIAs 测量的血清睾酮水平。
LC-MSMS 测量的血清睾酮中位数为 14.0ng/dL（范围 2.0-67.0ng/dL），CLIAs 测量的血清睾酮中位数为 31.9ng/dL（范围 10.0-91.6ng/dL）（P<0.001）。使用 LC-MSMS 测量时，83 例患者（65.9%）的血清睾酮水平<20ng/dL，40 例患者（31.7%）的血清睾酮水平为 20-50ng/dL，3 例患者（2.4%）的血清睾酮水平>50ng/dL。当使用 CLIAs 测量时，这些范围分别在 34 例患者（27%）、72 例患者（57.1%）和 20 例患者（15.9%）中发现（P<0.001）。使用 LC-MSMS 和 CLIAs 测量的血清睾酮去势水平分别为 39.8ng/dL（95%置信区间[CI]：37.1-43.4ng/dL）和 66.5ng/dL（95%CI：62.3-71.2ng/dL）。
我们发现 CLIAs 高估了接受 LHRH 激动剂治疗的 PCa 患者的睾酮水平。因此，近 15%的患者因使用 CLIAs 而错误地认为去势水平不足。使用适当方法的血清睾酮真正去势水平<50ng/dL。
