Low Serum Testosterone Levels Are Associated With Positive Surgical Margins in Radical Retropubic Prostatectomy: Hypogonadism Represents Bad Prognosis in Prostate Cancer

Telöken, Cláudio; Ros, Carlos Teodósio Da; Caraver, Fernanda; Weber, Fernanda A.; Cavalheiro, Ana P.; Graziottin, Túlio M.

doi:10.1097/01.ju.0000181818.51977.29

Cited by 107 publications

(93 citation statements)

References 19 publications

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“…The present study demonstrated that, compared with high levels of total serum testosterone at the time of diagnosis, low total serum testosterone levels at the time of diagnosis were associated with aggressive features of PCa, which is consistent with the results of previous studies (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). A previous pooled analysis of 18 prospective studies identified that pre-diagnosis serum testosterone levels were not associated with the high-risk form of PCa (32); however, the testosterone levels in this analysis were measured years prior to PCa diagnosis and a different definition of high-risk form of PCa was used.…”

Section: Discussionsupporting

confidence: 82%

“…A previous pooled analysis of 18 prospective studies identified that pre-diagnosis serum testosterone levels were not associated with the high-risk form of PCa (32); however, the testosterone levels in this analysis were measured years prior to PCa diagnosis and a different definition of high-risk form of PCa was used.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies on the association between testosterone and PCa risk have produced conflicting results (8,9). Numerous studies have demonstrated that low, rather than high, testosterone levels at diagnosis were associated with various markers of poor prognosis, including an advanced pathological stage, higher Gleason scores, higher PSA levels, seminal vesicle invasion and positive surgical margins (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Few studies have further investigated whether low levels of testosterone predict poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Low serum testosterone is associated with tumor aggressiveness and poor prognosis in prostate cancer

Meng

et al. 2017

Oncology Letters

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Abstract. Serum testosterone is a potential marker to distinguish between indolent and aggressive prostate cancer (PCa). The present study aimed to investigate whether low levels of total serum testosterone at diagnosis were associated with aggressive PCa and poor clinical outcomes. In total, 762 non-Hispanic Caucasian men with previously untreated PCa were recruited from The University of Texas MD Anderson Cancer Center (Houston, TX, USA). Patients were categorized into three groups based on their total serum testosterone levels according to clinical guidelines [low (<230 ng/dl), intermediate (230-350 ng/dl) and normal (>350 ng/dl)]. PCa aggressiveness (low-, intermediate-or high-risk, or metastatic) was compared using multinomial logistic regression. Rates of disease progression, mortality from any cause and PCa-specific mortality were compared using the multivariate Cox proportional hazards model. Testosterone levels significantly decreased as PCa aggressiveness increased (P<0.001). Compared with the normal testosterone group, the low testosterone group had 2.9-fold (OR, 2.92; 95% CI, 1.74-4.90; P<0.001), 5.6-fold (OR, 5.63; 95% CI, 3.14-10.12; P<0.001) and 72.4-fold (OR, 72.40; 95% CI,; P<0.001) increased risks of having intermediate-risk, high-risk and metastatic PCa, respectively. Furthermore, low levels of testosterone were significantly associated with a 10.7-fold (HR, 10.68; 95% CI, 1.35-84.44; P= 0.03) increased risk of PCa-specific mortality. The results of the present study indicate that low levels of total serum testosterone at diagnosis are associated with aggressive PCa and predict poor PCa-specific survival.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low serum testosterone is associated with tumor aggressiveness and poor prognosis in prostate cancer

Meng

et al. 2017

Oncology Letters

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“…A growing number of studies Other studies have described the relationship of lower T to more advanced disease. Recently, although only using a small study cohort, Teloken et al 20 from Brazil reported preoperative low T level was associated with positive surgical margin in RP. Similar results were found in a recent study of a large cohort of patients also treated with RP.…”

Section: Discussionmentioning

confidence: 99%

Does presence of prostate cancer affect serum testosterone levels in clinically localized prostate cancer patients?

Igarashi

Suzuki

Yano

et al. 2008

Prostate Cancer Prostatic Dis

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The relationships between serum level of testosterone (T) and prostate cancer (PCa) are complex. The present study evaluated whether presence of PCa alters serum T levels. Subjects were 125 patients with clinically localized PCa treated using radical prostatectomy (RP), for whom pretreatment T levels were recorded. We investigated clinical and pathological factors such as pretreatment serum T level, age, pretreatment prostate-specific antigen, Gleason score and pathological stage. Serum T and human luteinizing hormone (LH) levels before and after RP were then compared in 118 of the 125 patients. Mean pretreatment T level was significantly higher in patients with organ-confined PCa (pT2; 4.03 ± 1.50 ng ml À1) than in patients with nonorgan-confined cancer (pT3; 3.42±1.06 ng ml À1; P ¼ 0.0438). No association existed between pretreatment serum T level and pathological Gleason score. After RP, serum T level (5.60±1.90 ng ml À1 ) was significantly elevated compared to preoperative level (3.89 ± 1.43 ng ml À1 ; Po0.0001). In parallel, significant increases were seen in postoperative serum LH level (6.86 ± 3.64 ng ml À1 ) compared to preoperative level (5.11±2.47 ng ml À1; P ¼ 0.0001). In contrast, differences in serum T levels according to pathological stage disappeared postoperatively (P ¼ 0.5513). Significant increases in serum T and LH levels were seen after RP, compared to preoperative levels in parallel. This study suggests that serum T levels are altered by the presence of PCa, supporting the possibility that PCa may inhibit serum T levels with negative feedback in the hypothalamic-pituitary axis.

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“…[16][17][18][19][20] However, among men with prostate cancer, low endogenous testosterone has been associated with adverse prognostic features, including higher stage cancer, 21,22 higher Gleason scores, [23][24][25] higher frequency of positive surgical margins, 26 and decreased overall survival with metastatic disease. 27 Consistent with previous smaller investigations, in a review of 103 hypogonadal men with prostate cancer and a undetectable PSA following radical prostatectomy treated with TRT, there were no differences in the rates of biochemical recurrence compared to a reference group of 50 non-hypogonadal men.…”

Section: Introductionmentioning

confidence: 99%

Testosterone deficiency and replacement: Myths and realities

Grober¹

2014

CUAJ

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Testosteronedeficiency,orhypogonadism,iscommonandmayhave deleteriouseffectsonmen,includingdecreasedoverallwell-being, reducedsexualfunctionandboneloss.Despitedatademonstrating stronglinksbetweentestosteronedeficiencyandsignificantcomorbid conditions(includingtype2diabetesandmetabolicsyndromeaswell asthehealthbenefitsoftestosterone-replacementtherapy[TRT]),some physiciansarestillhesitanttoinitiatethesetherapies.Theirreluc-.TheirreluctanceisbasedonanumberofprevailingmythsassociatingTRTwith adverseprostatehealthandrecentconcernshighlightingthepossibility ofincreasedcardiovascularrisk.

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Low Serum Testosterone Levels Are Associated With Positive Surgical Margins in Radical Retropubic Prostatectomy: Hypogonadism Represents Bad Prognosis in Prostate Cancer

Abstract: Patients with low total testosterone more frequently present with positive surgical margins in RRP specimens. The true association between low testosterone and poor clinical outcome in the long term needs validation in large prospective studies.

Cited by 107 publications

References 19 publications

Low serum testosterone is associated with tumor aggressiveness and poor prognosis in prostate cancer

Low serum testosterone is associated with tumor aggressiveness and poor prognosis in prostate cancer

Does presence of prostate cancer affect serum testosterone levels in clinically localized prostate cancer patients?

Testosterone deficiency and replacement: Myths and realities

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