The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis

Abstract

Objective To evaluate whether pretreatment serum hormone levels are a prognostic factor for prostatic cancer with bony metastasis under hormonal treatment. Between 1980 and1994, 96 patients with prostate cancer and bony metastasis were included for an evaluation by a retrospective review of their charts. All 96 had received hormonal treatment after a diagnosis of metastatic prostatic carcinoma. Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were assessed before treatment. The patients were divided into two groups according to their response during the follow-up. Group 1 (good response) had no change or resolution of metastatic lesion(s) on the bone scan and a declining prostatespecific antigen (PSA) level. Group 2 had increased PSA or progression of metastatic lesion(s) on the bone scan. Tumours were graded as low (2-4), intermediate (5-7) and high (8-10) using the Gleason score. Patients and methodsResults There were 43 patients in group 1 and 53 in group 2; the overall mean (SD) age was 72.5 (6.8) years and the follow-up 29.5 (0.5) months. The respective mean (SD) levels of testosterone, LH, FSH and prolactin before treatment were 4.6 (1.6) ng/mL, 20.2 (13.3) mIU/mL, 19.6 (18.6) mIU/mL and 20.7 (12.1) ng/mL in group 1, and 2.6 (1.0) ng/mL, 27.3 (11.0) mIU/mL, 27.1 (9.8) mIU/mL and 41.3 (28.4) ng/mL in group 2. The level of testosterone was significantly higher in group 1 than in group 2, while LH, FSH and prolactin were significantly lower in group 1 than in group 2. When stratified by tumour grade, patients in group 1 still had significantly higher pretreatment testosterone and lower LH, FSH and prolactin than those in group 2. Conclusion Higher testosterone and lower LH, FSH and prolactin levels were good prognostic factors for patients with metastatic prostatic cancer under hormonal treatment, irrespective of tumour grading.

Association between Hormonal Evaluation Before Prostate Needle Biopsy and Locally Advanced Prostate Cancer

“…(11) 1941 yılında yapmış olduğu çalışmadan beri androjenler ile prostat ve prostat kanseri arasındaki ilişki araştırılmaktadır (12). Özellikle son yıllarda yapılan çalışmalarda metastatik, ileri evre ve kötü prognozlu prostat kanseri saptanan hastalarda serum TTE düzeyinin düşük olduğu gözlenmiştir (9,13,14). Bundan yola çıkarak yapılan çalışmalarda düşük TTE düzeyine sahip hastalarda da (özellikle <3 ng/ml) prostat kanserinin klinik olarak kötü seyirli, patolojik olarak ileri evre ve 5 yıllık nüks oranlarının ise yüksek olduğu gösterilmiştir (15,16,17,18,19).…”

Androgen receptor and prostate cancer

“…47 Paradoxically low pretreatment testosterone predicts a higher likelihood of non-organ confined disease in radical prostatectomy patients, as well as outcome for patients with bone metastatic disease. 48,49 Interestingly, high levels of AR is associated with aggressive clinicopathologic features and with decreased biochemical recurrence-free survival in CaP patients treated with radical prostatectomy. 50 These observations are consistent with reports demonstrating that increases in AR mRNA and protein levels are both necessary and sufficient to convert CaP growth from hormone-sensitive to a hormonerefractory stage, and is dependent on a functional AR ligand-binding domain.…”

Testosterone replacement therapy and the risk of prostate cancer. Is there a link?

“…40 In fact, there are strong indications that normal testosterone levels play a protective role in the natural history of prostate cancer. Many studies have demonstrated that a low testosterone level prior to treatment is an independent predictor of a more aggressive, highgrade cancer, 20 an increased likelihood of extraprostatic disease at the time of diagnosis, 41 and a decreased likelihood of a favorable treatment response. 42 Nevertheless, most of these trials are limited in sample size and duration of therapy.…”