Lower Testosterone Threshold in Advanced Prostate Cancer: Clinical Implications

A new analysis identifies the testosterone <10 ng/dL nadir as a prognostic discriminator in men with castration-resistant prostate cancer, suggesting a lower biochemical‑castration target may have clinical impact.

The analysis was a retrospective cohort study of several hundred men with advanced prostate cancer receiving androgen‑deprivation therapy. Investigators compared overall survival and time to progression between testosterone nadirs <10 ng/dL and 10–50 ng/dL.

Unlike the historical 50 ng/dL cutoff, the report found serum testosterone <10 ng/dL associated with better survival in advanced disease rather than reflecting only biochemical variation. The association was consistent across analyzed cohorts and remained after basic stratification, supporting a reproducible signal rather than random fluctuation.

Patients with nadirs <10 ng/dL had longer median time to progression and higher 3‑ and 5‑year survival rates than those in the traditional castrate range—differences that are clinically meaningful. Limitations include the observational design, potential selection and confounding biases, and variable assay methods and follow‑up schedules across patients.