Prevalence of Castration Success Rate in Iranian Metastatic Prostate Cancer Patients: A Referral Center Statistics


avatar Farzad Allameh ORCID 1 , avatar Amir Hossein Rahavian ORCID 1 , avatar Saleh Ghiasy ORCID 1 , *

Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

how to cite: Allameh F, Rahavian A H , Ghiasy S. Prevalence of Castration Success Rate in Iranian Metastatic Prostate Cancer Patients: A Referral Center Statistics. Int J Cancer Manag. 2018;11(10):e83613. doi: 10.5812/ijcm.83613.

Dear Editor,

Prostate cancer (PC) is the most common malignancy in men (1, 2). Choosing the appropriate treatment is important, especially in metastatic PC (3), and one of the treatments that is used, is luteinizing hormone-releasing hormone (LH-RH) agonist drugs that cause hormonal castration and tumor deprivation (4). But, in some cases, patients do not respond to this drugs and the level of testosterone failed to drop. In these cases, we require the use of other treatments (5, 6).

In this prospective study, after the approval of Ethics Committee was obtained, 36 patients with mean age of 71.86 ± 7.25 years (minimum 58 years and maximum 84 years), who were referred to Shohada-e-Tajrish Hospital, Tehran, Iran, were treated with LH-RH agonist (Diphereline® 3.75 mg IPSEN company) for 3 months. Serum prostate-specific antigen (PSA) and testosterone levels were evaluated in the two phases including before and 3 months after treatment; then, the frequency of the participants with testosterone level above 20 ng/dL (castration not achieved) were determined and reported based on the age and location of the metastasis.

Mean testosterone concentrations in the morning before and 3 months after starting hormone therapy were 362.94 ± 141.9 ng/dL and 12.21 ± 10.97 ng/dL, respectively, which was significantly decreased. The mean PSA level before and 3 months after the start of treatment was 20.68 ± 12.18 ng/mL and 6.29 ± 6.2 ng/mL, respectively. In two cases (5.6%), the PSA level was not less than 50% of the baseline 3 months after starting the treatment, and in 4 cases (11.1%), testosterone level did not drop to less than 20 ng/dL (castration not achieved). All four patients that have been considered as “castration not achieved” have been associated with multiple metastases. Three cases (75%) of these patients had visceral metastasis. It was found that the success in castration was significantly correlated with location of the metastasis (P = 0.001) and there was no correlation with age and number of metastases.

Table 1. Characteristic Data of Castration Failure Patientsa
NAgeMetastasis SiteGSBaseline PSA (ng/mL)Base Line Testosterone (ng/dL)PSA After 3 Month (ng/mL)Testosterone After 3 Month (ng/dL)
179Bone, liver and lung10100234.9865.586.9
266Bone and lung1054388.6145.757.9
366Bone and lung928364.210.323.45
473Only bone921.1459.97.627.87

Usually, the time required for hormonal castration after LH-RH agonist administration is 1 to 2 months, and the patients will follow up with PSA to evaluate the success of treatment.

In recent studies, there were cases of treatment failure that the patients after hormonal castration were presented with relapse and castration failures without increasing PSA (7).

Determining the prevalence of this group is very important in specification the effective factors in the castration success rate in patients with metastatic prostate cancer, and help to choose of appropriate alternative treatment. Currently, early chemotherapy is advised in patients with visceral metastasis (8, 9). The prevalence of castration success rate ranged from 47% to 90.5% in same studies (10). In this study, the prevalence of treatment success rate was 94.4% in patients, who were checked with PSA only and castration not achieved in 5.6% of patients, who were followed by PSA and 11.1 % of patients, who were checked with PSA and testosterone. Therefore, PSA checking would not seem to be sufficient only, and it would be advisable to check the level of testosterone alongside the PSA.

The present study showed that the prevalence of castration success rate by measuring serum testosterone level in Iranian metastatic prostate cancer patients underwent LH-RH agonist treatment was 88.9%.



  • 1.

    Allameh F, Qashqai H, Salavati A. A dynamic model for predicting prostate cancer in Iranian men based on a perceptron neural network. INT J Cancer Manag. 2017;10(3). doi: 10.5812/ijcm.7415.

  • 2.

    Abedi AR, Fallah-Karkan M, Allameh F, Ranjbar A, Shadmehr A. Incidental prostate cancer: A 10-year review of a tertiary center, Tehran, Iran. Res Rep Urol. 2018;10:1-6. doi: 10.2147/RRU.S146159. [PubMed: 29392121]. [PubMed Central: PMC5768285].

  • 3.

    Javanmard B, Yousefi M, Yaghoobi M, Hasanzadeh Hadad A, Amani M, et al. Ureteral reimplantation or Percutaneous nephrostomy: which one is better in management of complete ureteral obstruction due to advanced prostate cancer? Int J Cancer Manag. 2017;10(9). e6074. doi: 10.5812/ijcm.6074.

  • 4.

    Crawford ED. Hormonal therapy in prostate cancer: Historical approaches. Rev Urol. 2004;6 Suppl 7:S3-S11. [PubMed: 16985934]. [PubMed Central: PMC1472891].

  • 5.

    Gomella LG. Effective testosterone suppression for prostate cancer: Is there a best castration therapy? Rev Urol. 2009;11(2):52-60. [PubMed: 19680526]. [PubMed Central: PMC2725306].

  • 6.

    Denmeade SR, Isaacs JT. A history of prostate cancer treatment. Nat Rev Cancer. 2002;2(5):389-96. doi: 10.1038/nrc801. [PubMed: 12044015]. [PubMed Central: PMC4124639].

  • 7.

    Gravis G, Audenet F, Irani J, Timsit MO, Barthelemy P, Beuzeboc P, et al. Chemotherapy in hormone-sensitive metastatic prostate cancer: Evidences and uncertainties from the literature. Cancer Treat Rev. 2017;55:211-7. doi: 10.1016/j.ctrv.2016.09.008. [PubMed: 27665366].

  • 8.

    Reis LO. Variations of serum testosterone levels in prostate cancer patients under LH-releasing hormone therapy: An open question. Endocr Relat Cancer. 2012;19(3):R93-8. doi: 10.1530/ERC-12-0040. [PubMed: 22399012].

  • 9.

    Perlmutter MA, Lepor H. Androgen deprivation therapy in the treatment of advanced prostate cancer. Rev Urol. 2007;9 Suppl 1:S3-8. [PubMed: 17387371]. [PubMed Central: PMC1831539].

  • 10.

    Kirby M, Hirst C, Crawford ED. Characterising the castration-resistant prostate cancer population: A systematic review. Int J Clin Pract. 2011;65(11):1180-92. doi: 10.1111/j.1742-1241.2011.02799.x. [PubMed: 21995694].

Copyright © 2018, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.