Failure of Androgen-Deprivation Therapy Due to Ectopic hCG Secretion

This correspondence reports a rare case of a 57 year old man with prostate cancer whose testosterone levels failed to suppress during androgen-deprivation therapy (ADT) with GnRH agonists and antagonists, despite undetectable luteinizing hormone (LH) levels. Investigation revealed ectopic human chorionic gonadotropin (hCG) secretion from a concurrent high grade urothelial carcinoma with syncytiotrophoblasts, which stimulated testicular testosterone production via LH receptors. Following resection of the bladder tumor, hCG levels became undetectable, and testosterone suppression was achieved. The authors emphasize that nonsuppressible testosterone during ADT, coupled with low LH levels, should prompt evaluation for ectopic hCG production, particularly from germ cell or urothelial tumors. This case underscores the importance of considering alternative hormonal stimuli in ADT failure and highlights hCG measurement as a critical diagnostic step.

This correspondence reports a rare case of a 57 year old man with prostate cancer whose testosterone levels failed to suppress during androgen-deprivation therapy (ADT) with GnRH agonists and antagonists, despite undetectable luteinizing hormone (LH) levels. Investigation revealed ectopic human chorionic gonadotropin (hCG) secretion from a concurrent high grade urothelial carcinoma with syncytiotrophoblasts, which stimulated testicular testosterone production via LH receptors. Following resection of the bladder tumor, hCG levels became undetectable, and testosterone suppression was achieved. The authors emphasize that nonsuppressible testosterone during ADT, coupled with low LH levels, should prompt evaluation for ectopic hCG production, particularly from germ cell or urothelial tumors. This case underscores the importance of considering alternative hormonal stimuli in ADT failure and highlights hCG measurement as a critical diagnostic step.