Abstract: Prostate cancer is the most common male malignant tumor, ranking second among male malignant tumors. The incidence rate of prostate cancer is the highest in all male cancers. The incidence rate of China's prostate cancer is lower than that of western countries. However, with the westernization of lifestyle, the westernization of life habits and the prolongation of life expectancy, the incidence rate of prostate cancer is increasing year by year. Androgen receptor (AR) plays an important role in the pathophysiological mechanism of prostate cancer. Inhibiting AR signal transduction pathway is the basis of prostate cancer treatment. For example, in the treatment of castration-resistant prostate cancer (CRPC), AR antagonists can competitively bind AR and block the binding of endogenous androgen. Thus, it interferes with the downstream response of androgen dependent cells and prevents the progression of prostate cancer. Androgen deprivation therapy (ADT) is the cornerstone in the treatment of prostate cancer. According to the consensus of domestic experts, the effective testosterone (T) level for ADT is less than 50 ng/dL. Accumulated studies have shown that patients with T ＜ 20 ng/dL have better clinical prognosis. Lower T level (less than 20 ng/dL) results in more death of androgen-sensitive and some androgen-insensitive cells. During the treatment, androgen-sensitive cell populations can be obtained, thereby prolonging the duration to castration resistance. If T ＜ 20 ng/dL cannot be achieved, some androgen-insensitive subpopulations may persist. These subpopulations will proliferate rapidly after retreatment and accelerate the progression of tumor resistance to castration. The safety and effectiveness of gonadotropin-releasing hormone agonist (GnRHa), which controls T levels, have been verified by laboratory and clinical evidence, providing the clinical feasibility of controlling T at the level less than 20 ng/dL. This article reviewed the advances in the relationship between T level and ADT, and exhibited the drug efficacy, safety and patient benefits from the treatment of prostate cancer.

Key words: Prostate cancer, Testosterone, Gonadotropin-releasing hormone agonist