Testosterone as a predictor of pathological stage in clinically localized prostate cancer.

PURPOSE: Substantial controversy exists in the literature regarding the association between pretreatment testosterone and disease outcome in patients with prostate cancer. We explored the relationship between preoperative total testosterone, and pathological stage and progression in patients with clinically localized prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS: We retrospectively reviewed the records of consecutive patients with clinically localized prostate cancer treated with radical prostatectomy between January 1990 and June 2003. A total of 326 patients with pretreatment testosterone levels available were eligible for this analysis. Biochemical progression (BCR) was defined by postoperative prostate specific antigen (PSA) greater than 0.4 ng/ml with a confirmatory increase and it occurred in 41 men. No men received adjuvant therapy. Univariate and multivariate logistic regression analyses were done to examine whether pretreatment testosterone was associated with pathological stage. Cox regression was used to assess the association of testosterone and BCR. RESULTS: Median PSA was 6.01 ng/ml (range 0.13 to 86), testosterone was 385 ng/dl (range 133 to 998) and followup was 36 months (range 4 to 136). In 245 patients (75%) disease was organ confined. Lower testosterone correlated with adverse pathological stage on multivariate analysis (p = 0.01), as did clinical stage, biopsy grade and PSA. However, we found no relationship between testosterone and BCR after adjusting for covariates. Furthermore, we found no evidence of an interaction between PSA and testosterone (p = 0.4). CONCLUSIONS: On multivariate analysis low preoperative total testosterone was associated with advanced pathological stage but not with BCR. Future studies are warranted with data on more patients who have progressed

Testosterone and prostate safety

Objective: To review the safety of testosterone (T) therapy with regard to the prostate, with special emphasis on the controversial association between testosterone and prostate cancer. Methods: We reviewed the existing scientific and medical literature pertaining to the impact of T treatment on the prostate. Results: No large-scale, long-term controlled studies of T therapy versus placebo have yet been performed to document prostate safety. However, there is a wealth of evidence from smaller clinical trials as well as population-based longitudinal studies that fails to demonstrate any signal suggesting that T therapy in hypogonadal adult men poses an increased risk of prostate cancer. New evidence indicates that exogenous T does not raise intraprostatic T or dihydrotestosterone concentrations. Indeed, there is accumulating evidence that low serum T is associated with increased risk of prostate cancer and that these cancers may have more worrisome aggressive clinical features. In addition, multiple studies have failed to show that T therapy causes worsening of voiding symptoms due to benign prostatic hyperplasia. Conclusions: Despite the long-held belief that T therapy may pose an increased risk of prostate cancer, the available evidence strongly suggests that T therapy is safe for the prostate. Given that the population at risk for hypogonadism overlaps with the population at risk for prostate cancer, it is strongly recommended that men undergoing T therapy undergo regular monitoring for prostate cancer.SCOPUS: ch.binfo:eu-repo/semantics/publishe