Capitalizing on a cardiovascular research study bank in Sweden, the researchers evaluated men aged 33 to 50 years with prostate-specific antigen (PSA) measured in archived plasma. A nested Selleckchem ROCK inhibitor case-control design was employed, with three controls for each prostate cancer death. A single PSA reading at age 44 to 50 years was strongly predictive of prostate cancer death at a median follow-up of 27 years. Forty-four percent of deaths occurred in men at the 10th percentile of serum PSA level

(1.5 ng/mL). This is an important Inhibitors,research,lifescience,medical study and is giving support to the notion of stratifying men for interval early detection testing based on initial PSA results. The importance of nadir PSA during androgen deprivation therapy (ADT) was investigated by Keto and colleagues.2 Men who were treated with ADT for biochemical recurrence from the SEARCH data base were studied (322 patients).

PSA nadir, the lowest level obtained during followup, was analyzed. During a median follow-up of 51 months, the nadir level correlated with castrationresistant prostate cancer Inhibitors,research,lifescience,medical (CRPC), development of metastases, and prostate cancer-specific mortality. Relative to men with undetectable Inhibitors,research,lifescience,medical nadir, a PSA>0.2 ng/mL identified the greatest risk of progression. Although we often do not recognize it as an important marker, testosterone (T) in the setting of ADT truly is. Numerous studies have Inhibitors,research,lifescience,medical demonstrated better outcomes in men with lower and longer nadir T level compared with others on ADT. Pickles and Tyldesley3 studied T levels exceeding castration thresholds of 20, 32, and 50 ng/dL; 2290 men on continuous luteinizing

hormone-releasing hormone (LHRH) therapy were assessed. The risk of breakthrough T was 26.8%, 6.6%, and 3.3%, respectively, per patient course of ADT. Predisposing factors included younger age and higher body mass index (BMI), but not baseline T. Crawford and associates4 Inhibitors,research,lifescience,medical looked at baseline T levels in men on continuous ADT from two large clinical trials; 1669 men were evaluated. There were 1159 men from a trial of fracture prevention with toremifene citrate, 80 mg (any indication for ADT), and 510 men from a trial of sipuleucel-T (metastatic CRPC). Both trials required serum T < 50 ng/mL at baseline; 18.3% had T > 20 ng/dL. BMI correlated with men with higher T levels, although this did not persist in the subset of men who underwent orchiectomy. Neither patient age nor duration whatever of ADT predicted men who had serum T > 20 ng/dL. With the increasing evidence that the historically established definition of castration (T < 50 ng/dL) may not be adequate in all men, these two presentations demonstrate that increasing use of serum T determination in men on ADT is warranted. van der Sluis and colleagues5 addressed the issue of what the true castrate level of T is in men following LHRH therapy or surgical castration.