Is a Decreased Serum Testosterone Level a Risk Factor for Prostate Cancer? A Cohort Study of Korean Men

Abstract

PurposeTo investigate patients who had transrectal ultrasonography (TRUS)-guided prostate biopsy to define the role of the serum testosterone level in predicting prostate cancer risk and its association with a high Gleason score.Materials and MethodsA total of 568 patients who underwent prostate biopsy were entered in this study. We divided the patients into two groups according to serum testosterone level (median level, 3.85 ng/ml): the high-testosterone group (n=285) and the low-testosterone group (n=283). Multivariate regression analysis was used to define the effect of age, prostate volume, serum prostate-specific antigen (PSA) level and PSA density, and serum testosterone level on the risk of prostate cancer and a high Gleason score.ResultsBaseline characteristics did not differ significantly between the two groups. Compared with the high-testosterone group, the low-testosterone group had a significantly higher prostate cancer incidence (38.9% vs. 29.5%, p=0.018). Factors associated with an increased risk of prostate cancer were increased age (odds ratio [OR]=1.08, 95% confidence interval [CI]=1.25-3.16, p=0.001), a high serum PSA level (OR=3.35, 95% CI=2.63-4.25, p=0.001), a low prostate volume (OR=0.183, 95% CI=0.11-0.30, p=0.001), and a low serum testosterone level (OR=1.99, 95% CI=1.25-3.16, p=0.001). Among these, only the serum PSA level was a strong predictor of high-grade prostate cancer (Gleason score ≥7) (OR=2.19, 95% CI=1.57-2.95, p=0.001).ConclusionsPatients with lower levels of serum testosterone had a higher risk of prostate cancer than did patients with high serum testosterone. Even though a lower serum testosterone level was a predictor of prostate cancer risk, it was not associated with an increased risk of high-grade prostate cancer.

Low serum testosterone is a predictor of high-grade disease in patients with prostate cancer

“…10,11 However, an independent association has not been uniformly demonstrated in all investigations. 12,13 Most studies have been performed in Caucasian and Asian populations, yet without specifying the effect of demographic characteristics on the association between TT and higher-grade PCa. Possible explanations for the inconsistency between existing studies include demographic variability, variable cutoffs for hypogonadism and biased samples.…”

Low testosterone level is an independent risk factor for high‐grade prostate cancer detection at biopsy

“…Rather paradoxically, considerable studies targeting the biopsy or prostatectomy population reported that low testosterone levels were associated with the overall prostate cancer risk or high-grade prostate cancer risk. Moreover, some studies have reported that a low testosterone level is associated with unfavourable pathological findings in specimens and the biochemical recurrence rate after radical prostatectomy [14][15][16][17][18].…”

“…In fact, several studies have reported that a low level of testosterone is associated with increased detection of prostate cancer at biopsy, pathologically advanced prostate cancer, and a worse prognosis [12][13][14][15][16][17][18][19]. However, only a few results have been reported in the field of prostate biopsy, and they have not provided consistent conclusions.…”

“…However, only a few results have been reported in the field of prostate biopsy, and they have not provided consistent conclusions. Indeed, these papers adopted different definitions of low testosterone [14][15][16][20][21][22]. Therefore, we defined a low testosterone level according to the general standard and evaluated the impact of low testosterone on the detection of prostate cancer in a biopsy population.…”

Testosterone for the Treatment of Mammary and Prostate Cancers: Historical Perspectives and New Directions

“…Of even greater concern, neither prostate specific antigen (PSA), prostate volume, nor cancer progression has been found to increase with increasing testosterone levels in men with untreated prostate cancer (Morgentaler et al, 2011). Interestingly, evidence is even emerging to show that patients with a lower serum testosterone level may have a higher risk of prostate cancer than patients with high serum testosterone (Shin et al, 2010). Recent scrutiny of the seminal work conducted by Huggins and Hodges has revealed some fundamental flaws and methodological failings (Morgentaler, 2006).…”