Low serum testosterone is a predictor of high-grade disease in patients with prostate cancer

Abstract

Objective: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. Method: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. Results: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). Conclusion: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.

Free testosterone value before radical prostatectomy is related to oncologic outcomes and post-operative erectile function

“…These results were in accordance with the majority of the previous publications, and a number of mechanisms have been raised to explain the link between low TT value and tumor aggressiveness [7–9]. But still it’s notable that different results existed regarding this issue [4], and Albuquerque et al attribute this controversy to demographic variability between cohorts, and the possible co-existence of other undefined mechanisms [24]. Based on the results of the current study, we hypothesize that perhaps it’s FT that regulates the development and progression of PCa, and different proportion of FT in patients in previous studies might be the explanation for various results.…”

Low Serum Testosterone in Men with Newly Diagnosed Androgen-Deprivation Therapy-Naïve Prostate Cancer and Its Relationship to Cardiovascular Risk Factors: A RADICAL-PC Substudy

“…16 Our study included a substantially larger number of men, recruited from multiple centers and with varying cancer management plans. We found a higher rate of low T than previously reported, 14–16 which may be explained in part by our inclusion of men with more aggressive PC. Aggressive PC has been associated with low T in multiple studies, 17–19 a finding we are confirming.…”

“…In a single-center study of 423 men with PC undergoing radical prostatectomy, 37.8% of the patients had total T levels <300 ng/dL (<10.4 nmol/ L). 14 Using the same definition of low T, 24.1% of 673 ADT-na€ ıve patients undergoing radical prostatectomy presented with low T 15 and an even lower rate of low T of 15.2% was reported in another single-center cohort of 354 PC patients undergoing radical prostatectomy. 16 Our study included a substantially larger number of men, recruited from multiple centers and with varying cancer management plans.…”

Relationship between endogenous testosterone and prostate carcinoma

“…demonstrated that low testosterone level is an independent biomarker for high-grade prostate cancers in Black men. [ 7 ] According to this study, in localised prostate Ca, higher grade carcinoma was observed in patients with hypogonadism. This suggests serum testosterone levels could be a potential biomarker for prognosis in high-grade carcinoma prostate.…”