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

Park, Jae Young; Cho, Sung Yong; Jeong, Sangman; Lee, Seung Bae; Son, Hwancheol; Jeong, Hyeon

doi:10.1111/bju.13206

Cited by 34 publications

(29 citation statements)

References 37 publications

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“…This is in consonance with previous investigations. 9 Furthermore, low TT predicted high-grade PCa independently of age at diagnosis, which also opposes this conjecture. Rather, we believe that, according to the Saturation Model, patients with hypogonadism do not reach levels of testosterone necessary for physiological proliferation of the epithelium, leading to a greater risk of abnormal proliferation and differentiation, resulting in greater risk for high-grade cancer.…”

Section: Discussionmentioning

confidence: 96%

“…19 Similarly, Pichon et al showed, among subjects undergoing RP for PCa, that lower testosterone levels were associated with higher-grade PCa and with increased risk of GS upgrading from prostate biopsy to specimens from surgery. 20 Park et al 9 demonstrated a correlation between hypogonadism and unfavorable outcomes in prostatic biopsies, such as increased incidence of GS ≥ 8. Several studies, despite adopting different thresholds for the definition of hypogonadism, have confirmed an association between low testosterone levels and adverse characteristics and outcomes for PCa, including higher Gleason score, 21,22 higher pathological stage 10,22 and increased risk for disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…Park et al 9 retrospectively evaluated 681 patients undergoing prostate biopsy and found an independent association between laboratorial hypogonadism, defined as TT below 300 ng/dL, and high-grade PCa at biopsy. Studies performed in patients presenting PCa with clinically localized disease treated with radical prostatectomy (RP) also demonstrated that low levels of TT preoperatively were associated with more aggressive disease based on higher pathological stage, positive surgical margins and Gleason score (GS).…”

Section: Introductionmentioning

confidence: 99%

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

Albuquerque

Guglielmetti

Barbosa³

et al. 2017

Rev. Assoc. Med. Bras.

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Objective: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. Method: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. Results: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). Conclusion: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Albuquerque

Guglielmetti

Barbosa³

et al. 2017

Rev. Assoc. Med. Bras.

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“…24 We also examined mental health conditions that have been linked with low testosterone levels, including depression, 25 dementia, 26 schizophrenia, 27 and alcohol abuse. 28 We assessed obesity as a predictor, stratifying patients by body mass index (BMI).…”

Section: Independent Variables: Comorbid Conditions and Medicationsmentioning

confidence: 99%

Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study

et al. 2016

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BACKGROUND: There has been concern about the growing off-label use of testosterone. Understanding the context within which testosterone is prescribed may contribute to interventions to improve prescribing. OBJECTIVE: To evaluate patient characteristics associated with receipt of testosterone. DESIGN: Cross-sectional. SETTING: A national cohort of male patients, who had received at least one outpatient prescription within the Veterans Affairs (VA) system during Fiscal Year 2008-Fiscal Year 2012. PARTICIPANTS: The study sample consisted of 682,915 non-HIV male patients, of whom 132,764 had received testosterone and a random 10% sample, 550,151, had not. MAIN MEASURES: Conditions and medications associated with testosterone prescription. KEY RESULTS: Only 6.3% of men who received testosterone from the VA during the study period had a disorder of the testis, pituitary or hypothalamus associated with male hypogonadism. Among patients without a diagnosed disorder of hypogonadism, the use of opioids and obesity were the strongest predictors of testosterone prescription. Patients receiving >100 mg/equivalents of oral morphine daily (adjusted odds ratio = 5.75, p < 0.001) and those with body mass index (BMI) >40 kg/m 2 (adjusted odds ratio = 3.01, p < 0.001) were more likely to receive testosterone than non-opioid users and men with BMI <25 kg/m 2 . Certain demographics (age 40-54, White race), comorbid conditions (sleep apnea, depression, and diabetes), and medications (antidepressants, systemic corticosteroids) also predicted a higher likelihood of testosterone receipt, all with an adjusted odds ratio less than 2 (p < 0.001). CONCLUSIONS: In the VA, 93.7% of men receiving testosterone did not have a diagnosed condition of the testes, pituitary, or hypothalamus. The strongest predictors of testosterone receipt (e.g., obesity, receipt of opioids), which though are associated with unapproved, off-label use, may be valid reasons for therapy. Interventions should aim to increase the proportion of testosterone recipients who have a valid indication.

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“…In a recent study of 681 men undergoing a 12-core prostate biopsy, low testosterone level was found to be an independent risk factor for high-grade prostate cancer. 7 Similarly, Garcia-Cruz et al found that low pretreatment testosterone levels were significantly related to poor prognostic factors. 8 While the aetiology of low testosterone in high-grade prostate cancer patients remains uncertain, the body of evidence for this relationship continues to grow, leading some to suggest that monitoring testosterone levels prior to biopsy may provide prognostic information.…”

Section: Wisdom Challengedmentioning

confidence: 95%

Prostate cancer and testosterone replacement therapy: what is the risk?

Carson¹,

Kirby

2017

Trends Urology & Men Health

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T he last decade has seen a rise in testosterone replacement therapy (TRT) internationally.1 Controversy continues, however, on the impact of TRT and its effect on the prostate. While the effects of TRT on benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) are as yet unsettled, the role of TRT in prostate cancer appears to be clearer.The effects of testosterone and castration on the prostate and prostate cancer have a long history, with the sentinel publication of Charles Huggins and Clarence V. Hodges in 1941 as the first clear demonstration of the effects of withdrawing testosterone by castration or oestrogen on the progression of prostate cancer. 2 In that publication, the authors also showed that, in a single patient, withdrawal of testosterone by castration and subsequent replacement of testosterone had the deleterious effect of causing the prostate cancer to first involute then regrow. This publication and subsequent reviews and presentations led to the conventional wisdom that testosterone could cause prostate cancer, and that TRT could either induce de novo prostate cancer or unearth an occult prostate malignancy.

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

Cited by 34 publications

References 37 publications

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

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

Who Gets Testosterone? Patient Characteristics Associated with Testosterone Prescribing in the Veteran Affairs System: a Cross-Sectional Study

Prostate cancer and testosterone replacement therapy: what is the risk?

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