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

Baixa testosterona sérica é prognóstica de doença de alto grau em pacientes com câncer de próstata

George A. M. Lins de Albuquerque Giuliano B. Guglielmetti João Arthur B. A. Barbosa José Pontes Jr. Arnaldo J. C. Fazoli Maurício D. Cordeiro Rafael F. Coelho Paulo Afonso de Carvalho Fábio P. Gallucci Guilherme P. Padovani Rubens Park José Cury Henrique Nonemacher Miguel Srougi William C. Nahas About the authors

Summary

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.

Keywords:
prostate cancer; hypogonadism; testosterone

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