Low Testosterone and Risk of Biochemical Recurrence and Poorly Differentiated Prostate Cancer at Radical Prostatectomy

Objectives: To evaluate, in a prospective study, the association between low testosterone and pathologic endpoints and the risk of biochemical progression. Androgens play a key role in prostate cancer progression. The results from 3 retrospective studies have suggested that low pretreatment testosterone is an independent predictor of adverse pathologic features in patients with localized prostate cancer.

Methods: Routine preoperative total testosterone values were measured in 455 consecutive patients with clinically localized prostate cancer who underwent radical prostatectomy. The association of low testosterone levels (defined a priori as <220 ng/dL) with the pathologic endpoints and the risk of biochemical recurrence using a validated postoperative nomogram was evaluated in univariate and multivariate analyses.

Results: No association between low testosterone and the predicted risk of biochemical recurrence (P = .159) or actual disease progression (P = .9) was observed. On multivariate analysis, low testosterone was associated with a predominance of Gleason pattern 4-5 cancer (odds ratio 2.4, 95% confidence interval 1.01-5.7; P = .048). No association of low testosterone with tumor volume was observed (P = .9).

Conclusions: In this prospective study, low pretreatment total testosterone was associated with Gleason pattern 4-5 cancer at prostatectomy, but not with disease progression thereafter. The clinical utility of the serum testosterone level for patients with localized prostate cancer is therefore marginal. These data are consistent with the hypothesis that tumors arising in a low-androgen environment might appear to be of higher grade but are not at increased risk of progression.