Korean J Urol.  2012 Jan;53(1):9-13. 10.4111/kju.2012.53.1.9.

Usefulness of Preoperative Serum Testosterone as a Predictor of Extraprostatic Extension and Biochemical Recurrence

• Kim HJ
• Kim BH
• Park CH
• Kim CI

• KMID: 1988816
• DOI: http://doi.org/10.4111/kju.2012.53.1.9

Abstract

PURPOSE
A great variety of studies on preoperative serum testosterone as a predictor of progression of prostate cancer have been reported recently. The purpose of this study was to investigate the relationship of preoperative serum testosterone levels in patients who underwent radical prostatectomy with prognostic factors.
MATERIALS AND METHODS
Clinical data were collected from 60 patients who underwent radical prostatectomy. The 60 cases were divided into 2 groups according to their preoperative serum testosterone levels: group 1 (n=21), <3 ng/ml; group 2 (n=39), > or =3 ng/ml. The groups were compared according to prog-ression factors. Multivariate logistic regression analysis was performed to determine the correlation between biochemical recurrence and each variable.
RESULTS
The incidence of extraprostatic invasions was significantly higher in group 1 with 13 cases in group 1 (61.9%) and 11 cases in group 2 (28.2%) (p=0.011). The incidence of biochemical recurrence was also significantly higher in group 1 with 5 cases in group 1 (23.8%) and 2 cases in group 2 (5.1%) (p=0.032). A low serum testosterone level (< or =3 ng/ml) was associated with an increased risk of biochemical recurrence (odds ratio [OR], 13.64; 95% confidence interval [CI], 1.66 to 2.43; p=0.015) and an increased risk of extraprostatic invasions (OR, 4.96; 95% CI, 1.41 to 17.38; p=0.012).
CONCLUSIONS
The incidence rates of extraprostatic invasions and biochemical recurrence were significantly higher in the group with preoperative average serum testosterone of less than 3 ng/ml. Therefore, these results suggest that preoperative average serum testosterone will be useful in predicting postoperative prostate cancer progression.

Keyword

Disease progression; Prostatic neoplasms; Testosterone

MeSH Terms

Disease Progression
Humans
Incidence
Logistic Models
Prostatectomy
Prostatic Neoplasms
Recurrence
Testosterone
Testosterone

Reference

1. Prehn RT. On the prevention and therapy of prostate cancer by androgen administration. Cancer Res. 1999. 59:4161–4164.

2. Lucia MS, Bostwick DG, Bosland M, Cockett AT, Knapp DW, Leav I, et al. Workgroup I: rodent models of prostate cancer. Prostate. 1998. 36:49–55.

3. Ribeiro M, Ruff P, Falkson G. Low serum testosterone and younger age predict for a poor outcome in metastatic prostate cancer. Am J Clin Oncol. 1997. 20:605–608.

4. Chodak GW, Vogelzang NJ, Caplan RJ, Soloway M, Smith JA. The Zoladex Study Group. Independent prognostic factors in patients with metastatic (stage D2) prostate cancer. JAMA. 1991. 265:618–621.

5. Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989. 142:71–74.

6. Presti JC Jr, O'Dowd GJ, Miller MC, Mattu R, Veltri RW. Extended peripheral zone biopsy schemes increase cancer detection rates and minimize variance in prostate specific antigen and age related cancer rates: results of a community multi-practice study. J Urol. 2003. 169:125–129.

7. Hoffman MA, DeWolf WC, Morgentaler A. Is low serum free testosterone a maker for high grade prostate cancer? J Urol. 2000. 163:824–827.

8. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice gulidline. J Clin Endocrinol Metab. 2010. 95:2536–2559.

9. Carson C 3rd, Rittmaster R. The role of dihydrotestosterone in benign prostatic hyperplasia. Urology. 2003. 61:4 Suppl 1. 2–7.

10. Heemers HV, Tindall DJ. Androgen receptor (AR) coregulators: a diversity of functions converging on and regulating the AR transcriptional complex. Endor Rev. 2007. 28:778–808.

11. Huggins C, Stevens RE Jr, Hodges CV. Stduies on prostate cancer: II .The effect of castration on advanced carcinonma of the prostate gland. Arch Surg. 1941. 43:209–223.

12. Adlercreutz H, Rannikko S, Kairento AL, Karonen SL. Hormonal pattern in prostate cancer. II. Correlation with primary response to endocrine treatment. Acta Endocrinol (Copenh). 1981. 98:634–640.

13. Chen SS, Chen KK, Lin AT, Chang YH, Wu HH, Chang LS. The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis. BJU Int. 2002. 89:710–713.

14. Massengill JC, Sun L, Moul JW, Wu H, McLeod DG, Amling C, et al. Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol. 2003. 169:1670–1675.

15. Teloken C, Da Ros CT, Caraver F, Weber FA, Cavalheiro AP, Graziottin TM. Low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy: hypogonadism represents bad prognosis in prostate cancer. J Urol. 2005. 174:2178–2180.

16. Yamamoto S, Yonese J, Kawakami S, Ohkubo Y, Tatokoro M, Komai Y, et al. Preoperative serum testosterone level as an independent predictor of treatment failure following radical prostatectomy. Eur Urol. 2007. 52:696–701.

17. Zhang PL, Rosen S, Veeramachaneni R, Kao J, DeWolf WC, Bubley G. Association between prostate cancer and serum testosterone levels. Prostate. 2002. 53:179–182.

18. Schatzl G, Madersbacher S, Thurridl T, Waldmüller J, Kramer G, Haitel A, et al. High-grade prostate cancer is associated with lower serum testosterone levels. Prostate. 2001. 47:52–58.

19. Schalken JA. Molecular aspects of hormone-independent prostate cancer. BJU Int. 2007. 100:Suppl 2. 52–55.

20. Morgentaler A. Testosterone and prostate cancer: an historical perspective on modern myth. Eur Urol. 2006. 50:935–939.

21. Koo JM, Shim BS. Significance of serum testosterone for prostate-specific antigen (PSA) elevation and prediction of prostate cancer in patients with PSA above 10 ng/ml. Korean J Urol. 2010. 51:831–835.

22. Miller LR, Partin AW, Chan DW, Bruzek DJ, Dobs AS, Epstein JI, et al. Influence of radical prostatectomy on serum hormone levels. J Urol. 1998. 160:449–453.

23. Risbridger GP, Thomas T, Gurusinghe CJ, McFarlane JR. Inhibin-related proteins in rat prostate. J Endocrinol. 1996. 149:93–99.

24. Lokeshwar BL, Hurkadli KS, Sheth AR, Block NL. Human prostatic inhibin suppresses tumor growth and inhibits clonogenic cell survival of model prostatic adenocarcinoma, the Dunning R3327G rat tumor. Cancer Res. 1993. 53:4855–4859.

25. Sheth AR, Grade SV, Mehta MK, Shah MG. Hormonal modulation of biosynthesis of prostatatic specific antigen, prostate specific acid phosphatase and prostate inhibin peptide. Indian J Exp Biol. 1992. 30:157–161.

26. Freedland SJ, Isaacs WB, Platz EA, Terris MK, Aronson WJ, Amling CL, et al. Prostate size and risk high-grade, advanced prostate cancer and biochmical progression after radical prostatectomy: a search database study. J Clin Oncol. 2005. 23:7546–7554.

27. Marks LS, Mazer NA, Mostaghel E, Hess DL, Dorey FJ, Epstein JI, et al. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA. 2006. 296:2351–2361.

28. Scardino PT. The prevention of prostate cancer-the dilemma continues. N Engl J Med. 2003. 349:297–299.

29. Morgentaler A, Bruning CO 3rd, DeWolf WC. Occult prostate cancer in men with low serum testosterone levels. JAMA. 1996. 276:1904–1906.