A systematic review of 29 studies examined testosterone monitoring and recovery in men with intermediate to high-risk prostate cancer treated with radiotherapy and androgen deprivation therapy (ADT). Baseline testosterone strongly predicted subsequent testosterone recovery: men who started ADT with lower testosterone were more likely to have slower or incomplete recovery. Duration of ADT also strongly predicted median time to eugonadal recovery spanning just over a year following completion of short-course ADT to over 5 years following completion of 36 months of ADT. Deeper testosterone suppression (<20 ng/dL) appeared associated with better biochemical control than the traditional <50 ng/dL castration threshold, although the evidence is heterogeneous. Finally, limited observational data suggest testosterone replacement may be oncologically safe in carefully selected men, but evidence in high-risk patients remains sparse. | Achard, Radioth Oncol 2026
