Low testosterone at first prostate‐specific antigen failure and assessment of risk of death in men with unfavorable‐risk prostate cancer treated on prospective clinical trials

Atkins, Katelyn M.; Chen, Ming Hui; Wu, Jing; Renshaw, Andrew A.; Loffredo, Marian; Small, Eric J.; D’Amico, Anthony V.

doi:10.1002/cncr.31204

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…These interventions could be implemented at a time before PSA failure, but when castrate resistance is suspected, based on a measurable PSA despite castrate levels of testosterone. 22 Therefore, in the current study, we investigate the prognostic significance of TTN, stratified by a detectable versus undetectable PSA nadir and adjusted for age, comorbidity, and known CaP prognostic factors, in men with newly diagnosed unfavorable risk prostate cancer using long term follow-up data from a randomized controlled trial that compared definitive radiation therapy (RT) with or without ADT. 23,24…”

Section: Introductionmentioning

confidence: 99%

Time to Prostate-specific Antigen Nadir and the Risk of Death From Prostate Cancer Following Radiation and Androgen Deprivation Therapy

Pike

Chen

et al. 2019

Urology

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Section: Introductionmentioning

confidence: 99%

Time to Prostate-specific Antigen Nadir and the Risk of Death From Prostate Cancer Following Radiation and Androgen Deprivation Therapy

Pike

Chen

et al. 2019

Urology

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“…After removing duplicates, 785 papers were screened and 40 full-text articles were selected and individually evaluated for eligibility. Finally, 19 studies were included for quantitative and qualitative analysis [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Prognostic impact of serum testosterone in metastatic hormone-naive prostate cancer: a systematic review and meta-analysis

Puche-Sanz,

Chiu,

Morillo

et al. 2023

Current Opinion in Urology

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Purpose of review In daily practice, there is an unmet medical need for biomarkers that facilitate therapeutic decision-making in the metastatic hormone sensitive prostate cancer (mHSPC) scenario. Although recent studies have highlighted the potential of testosterone as a prognostic and predictive marker in prostate cancer, the evidence is controversial. The objective of this review was to summarize and analyze the scientific evidence regarding the prognostic role of basal testosterone levels in patients with mHSPC. Methods A systematic review was performed. Three authors selected the articles from Web of Science, PubMed, Scopus, and Cochrane Library electronic databases. Risk of bias was assessed by the Newcastle Ottawa Scale. Recent findings Most of the selected articles suggest that low testosterone levels before starting hormonal blockade imply a worse prognosis for patients with mHSPC. However, the quality of the evidence is poor, the studies are heterogeneous, and it is not possible to meta-analyze most of the published results. Summary Testosterone is an accessible and affordable biomarker. If it were correctly demonstrated that it harbors a prognostic and/or predictive role in the mHSPC setting, it could represent an advance in decision-making in these patients. Well designed prospective studies are needed to correctly answer this question.

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“…An earlier investigation had previously shown that a low, but not necessarily castrate testosterone level at the time of PSA failure, 24 conferred a very poor prognosis 25 . However, it remains unclear whether the prognostic significance of PSAn and low testosterone at PSA failure is independent or overlapping.…”

Section: Introductionmentioning

confidence: 99%

Prostate‐specific antigen nadir and testosterone level at prostate‐specific antigen failure following radiation and androgen suppression therapy for unfavorable‐risk prostate cancer and the risk of all‐cause and prostate cancer–specific mortality

Bitterman

Chen

et al. 2021

Cancer

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BACKGROUND Although both PSA nadir (PSAn) and testosterone levels at PSA failure are known prognostic factors in men undergoing radiation therapy (RT) and androgen deprivation therapy (ADT) for unfavorable‐risk prostate cancer (PC), it is unclear whether their prognostic significance is independent or overlapping. METHODS Seventy‐five men treated with RT with or without 6 months of ADT for unfavorable‐risk nonmetastatic PC enrolled in 2 prospective clinical trials between 1986 and 2001 formed the study cohort. Competing risks and Cox multivariable regression were used to assess whether low versus normal serum testosterone at the time of PSA failure and higher PSAn after initial therapy were independently associated with the risk of PC‐specific (PCSM) and all‐cause mortality (ACM) adjusting for PC prognostic factors. RESULTS After a median follow‐up of 15.34 years (interquartile range, 6.66‐16.88 years), there were 53 deaths (73.3%): 30 (56.6%) were from PC. Low testosterone at PSA failure was significantly associated with an increased risk of PCSM (adjusted HR [AHR], 7.77; 95% CI, 1.14‐52.99; P = .04) and ACM (AHR, 3.01; 95% CI, 1.01‐8.96; P = .05), as was higher PSAn (PCSM AHR, 1.03; 95% CI, 1.01‐1.05; P < .01; ACM AHR, 1.04; 95% CI, 1.02‐1.07; P < .01), although the prognostic significance of PSAn was only noted in men with a normal testosterone at PSA failure. CONCLUSIONS Low testosterone level at PSA failure in high‐risk patients with PC treated with RT is associated with increased PCSM and ACM risk. In men with normal testosterone levels at the time of PSA failure, an elevated PSAn was associated with worse PCSM and ACM risk. LAY SUMMARY This study investigates whether the prostate‐specific antigen (PSA) nadir and normal versus low testosterone at the time of PSA failure provide mutually exclusive or overlapping prognostic information following treatment with radiation and androgen deprivation therapy for unfavorable‐risk patients with prostate cancer using data from 2 prospective clinical trials. It was found that both provided prognostic information; however, higher PSA nadir was only found to be of prognostic significance in men with normal testosterone levels at PSA failure.

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Low testosterone at first prostate‐specific antigen failure and assessment of risk of death in men with unfavorable‐risk prostate cancer treated on prospective clinical trials

Cited by 5 publications

References 44 publications

Time to Prostate-specific Antigen Nadir and the Risk of Death From Prostate Cancer Following Radiation and Androgen Deprivation Therapy

Time to Prostate-specific Antigen Nadir and the Risk of Death From Prostate Cancer Following Radiation and Androgen Deprivation Therapy

Prognostic impact of serum testosterone in metastatic hormone-naive prostate cancer: a systematic review and meta-analysis

Prostate‐specific antigen nadir and testosterone level at prostate‐specific antigen failure following radiation and androgen suppression therapy for unfavorable‐risk prostate cancer and the risk of all‐cause and prostate cancer–specific mortality

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