Low testosterone level predicts prostate cancer in re‐biopsy in patients with high grade prostatic intraepithelial neoplasia

Garcı́a-Cruz, E.; Piqueras, Marta; Ribal, María J.; Huguet, J.; Serapiao, Rodrigo; Peri, Lluís; Izquierdo, Laura; Alcaraz, Antonio

doi:10.1111/j.1464-410x.2011.10876.x

Cited by 29 publications

(17 citation statements)

References 27 publications

(31 reference statements)

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“…Rhoden and Morgentaler treated 20 men with HGPIN and 55 men with negative biopsies with 12 months of TRT, and observed no changes in PSA or DRE [Rhoden and Morgentaler, 2003]. This is in agreement with a separate study demonstrating higher incidence of PrCa on re-biopsy in men with HGPIN and lower serum testosterone levels [Garcia-Cruz et al 2012].…”

Section: Trt In Patients Without Prcasupporting

confidence: 79%

Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk

Michaud¹,

Billups

Partin

2015

Therapeutic Advances in Urology

107

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Testosterone plays a central role in male development and health. Likewise, androgen deficiency, or hypogonadism, is associated with a variety of symptoms including decreased energy, diminished libido and erectile dysfunction, among others. Male androgen levels steadily decline with age, and, in a subset of symptomatic older men, can result in late-onset hypogonadism (LOH). Over the last decade, increased awareness of hypogonadism among patients and providers has led to a significant rise in the use of testosterone replacement therapy (TRT) for hypogonadism, and especially in LOH. Accompanying the rise in TRT are concerns of potential adverse effects, including cardiovascular risks and the promotion of prostate cancer. The 'androgen hypothesis' asserts that prostate cancer development and progression is driven by androgens, and thus TRT has the theoretical potential to drive prostate cancer development and progression. In this review, we examine existing data surrounding testosterone and prostate cancer. There is significant evidence that androgens promote prostate cancer in experimental systems. However, there is no clear evidence that elevations in endogenous testosterone levels promote the development of prostate cancer in humans. As a result of experimental and historical data on the progression of prostate cancer following TRT, there has been widespread belief that TRT will promote disease progression in prostate cancer patients. Despite these fears, there are a growing number of studies demonstrating no increase in prostate cancer incidence among men on TRT. Furthermore, in studies involving a small number of patients, there has been no discernable increase in disease progression in prostate cancer patients on TRT. While data from large, prospective, randomized, controlled trials are absent, TRT in select prostate cancer patients is likely safe. In the end, the use of TRT in prostate cancer patients is still considered experimental and should only be offered after well-informed shared decision making and with close monitoring.

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Section: Trt In Patients Without Prcasupporting

confidence: 79%

Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk

Michaud¹,

Billups

Partin

2015

Therapeutic Advances in Urology

107

View full text Add to dashboard Cite

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“…Furthermore, previous studies had also showed that the levels of total testosterone and SHBG were negatively associated with metabolic syndrome [16] while the levels of serum ferritin was in a positive association with metabolic syndrome [3]. In prostate cancer, lower testosterone or higher ferritin levels was related with poorer diagnosis or estimation relatively [38]–[40]. Besides, serum ferritin was considered as a risk factor [3] while the sex hormone may benefit for women in cardiovascular diseases [22].…”

Section: Discussionmentioning

confidence: 99%

The Association between the Levels of Serum Ferritin and Sex Hormones in a Large Scale of Chinese Male Population

Liu

Zhang

et al. 2013

PLoS ONE

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BackgroundThe ferritin is an important participant of iron-storage but its regulation and related factors were not well defined. The present objective was to explore the potential association between serum ferritin levels and sex hormones.Methods1999 Chinese men in the Fangchenggang Area Male Health and Examination Survey (FAMHES) were recruited in this cross-sectional study. Levels of serum ferritin, total testosterone (free testosterone was calculated from the total one), estradiol and sex hormone-binding protein were detected in venous blood samples. The effects of age, BMI, smoking as well as alcohol consumption were analyzed on ferritin levels, respectively, and then the Pearson’s correlation analysis was used to evaluate the association between ferritin levels and sex hormones adjusting for the above factors.ResultsThe age, BMI and alcohol consumption significantly affected serum ferritin levels, but there was no significant difference between smokers and nonsmokers. Ferritin levels were significantly and negatively associated with total testosterone (R = −0.205, P< 0.001), sex hormone-binding protein (R = −0.161, P<0.001) and free testosterone (R = −0.097, P<0.001). After age and alcohol consumption were adjusted, the above associations were still significant (R = −0.200, −0.181 and −0.083, respectively, all P<0.001). However, there was only borderline negative association between ferritin levels and estradiol (adjusted R = −0.039, P = 0.083).ConclusionThe large scale of epidemic results showed the significantly negative associations between serum ferritin levels and sex hormones, which may provide more clues to explore the potential regulation and biological mechanism of ferritin.

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“…Even though the present study did not show that ERG is useful to predict PCa risk after an HGPIN diagnosis, other molecular markers may be of predictive value for PCa risk in such a setting. For example, AMACR [10], PTOV1 [11], APC [12] and testosterone [34] have been found to be useful to determine which HGPIN patients are at higher cancer risk. Of course, these molecular markers need to be validated in large studies.…”

Section: Discussionmentioning

confidence: 99%

Expression of ERG protein, a prostate cancer specific marker, in high grade prostatic intraepithelial neoplasia (HGPIN): lack of utility to stratify cancer risks associated with HGPIN

Osunkoya

Carver

et al. 2012

BJU International

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E 7 5 1What ' s known on the subject? and What does the study add? High grade prostatic intraepithelial neoplasia is a pre-malignant lesion to prostate cancer and is associated with 20% -25% risk of prostate cancer in subsequent repeat biopsies. ERG is a highly prostate-cancer-specifi c marker.Expression of ERG is rare in isolated high grade prostatic intraepithelial neoplasia diagnosed in prostate biopsy and is not associated with cancer risk in subsequent repeat biopsies. OBJECTIVES• To evaluate how often ERG, a highly prostate-cancer-specifi c marker, is expressed in isolated high grade prostatic intraepithelial neoplasia (HGPIN) by immunohistochemistry.• To study whether a positive ERG immunostain in HGPIN correlates with prostate cancer (PCa) detection in subsequent repeat biopsies. PATIENTS AND METHODS• Patients with initial HGPIN in biopsies and at least one follow-up prostate biopsy were included.• Biopsies with HGPIN were immunostained for ERG.• The ERG staining results were then correlated with the PCa risk in subsequent biopsies. RESULTS• The mean age of 94 patients was 63 years (range 48 -78). A mean of 1.8 (range 1 -5) repeat biopsy sessions were carried out at a mean interval of 27.4 months (range 1.5 -140). The repeat biopsies showed PCa and non-cancer lesions (benign, HGPIN, atypical glands suspicious for cancer) in 36 patients (38%) and 58 patients (62%) respectively.• ERG immunostain was positive in fi ve (5.3%) biopsies with HGPIN, in which PCa was found in two (40%) subsequent biopsies. Of 89 biopsies with negative ERG staining, PCa was found in 34 (38%) repeat biopsies. The cancer detection rate was not different between ERG positive and negative cases ( P = 0.299). CONCLUSIONS• This is the fi rst study to investigate the ERG protein expression in prostate biopsy containing HGPIN only and its use to stratify the cancer risk associated with HGPIN. We found that ERG expression is distinctly uncommon in isolated HGPIN (5.3%).• Positive ERG expression is not associated with increased cancer detection in subsequent repeat biopsies. The use of ERG immunostain in the evaluation and cancer risk stratifi cation of HGPIN is of limited value.

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Low testosterone level predicts prostate cancer in re‐biopsy in patients with high grade prostatic intraepithelial neoplasia

Cited by 29 publications

References 27 publications

Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk

Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk

The Association between the Levels of Serum Ferritin and Sex Hormones in a Large Scale of Chinese Male Population

Expression of ERG protein, a prostate cancer specific marker, in high grade prostatic intraepithelial neoplasia (HGPIN): lack of utility to stratify cancer risks associated with HGPIN

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