Urinary testosterone as a marker of risk of recurrence in operable breast cancer

Abstract

We investigated the role of urinary testosterone levels as a marker of risk of recurrent disease in 113 operable breast cancer patients (70 premenopausal, 43 postmenopausal). Twenty-four-hour urine collections for testosterone measurement were obtained before surgical treatment, between 20-40 days thereafter, and then every 6 months for 5 years. The cutoff values to separate 'high testosterone (A+)' from 'normal testosterone (A-)' were 8.0 micrograms/24 h in premenopause and 4.9 micrograms/24 h in postmenopause. Urinary testosterone levels were considered high when they exceeded the cutoff value in at least 2 of the first 3 measurements (pretreatment, post-treatment, 6 months) of each patient. According to the aforementioned criterion, 33 patients (29.2%) had high testosterone levels, which were associated to axillary node involvement in 16 patients. Thirteen of the latter relapsed during the 5-year follow-up period (5/7 in premenopause, 8/9 in postmenopause). Relapse-free survival (RFS) curves were drawn only for node-positive patients owning to the small number of recurrences observed in the node-negative group. In premenopausal node-positive patients, RFS was significantly different for patients presenting high and normal urinary testosterone levels (77% vs 28%, respectively; logrank test, p < 0.006). In postmenopausal node-positive patients, RFS was also different between the two groups (54% vs 11% in 'high' and 'normal' excretors, respectively) but the difference was not statistically significant. The present findings suggest that urinary testosterone is a prognostic indicator of early breast cancer recurrence in node-positive patients.

Testosterone and Biological Characteristics of Breast Cancers in Postmenopausal Women

“…Previous studies by our group on metastatic breast cancers, in which remission of metastases was associated with normalization of androgen levels (24)(25)(26)(27), also point to high testosterone as a marker of hormone-dependent cancer. In other studies on early breast cancer patients, we found that the frequency of disease progression was greater in patients with high urinary androgens compared with those with normal levels (28) and, more recently, that use of diet to lower circulating testosterone reduced the frequency of disease progression (29). Based on the findings of the present study and those reviewed above, we propose that testosterone levels should be routinely determined during both the workup of newly diagnosed postmenopausal breast cancer patients and during follow-up.…”

Urinary steroids in premenopausal women with breast cancer at the time of surgery

“…The effect of these steroids in the risk of breast cancer [5,11,12,16], risk of recurrence [4,17] or in survival [4,13] has also been intensively investigated.…”