A new study has found that patients with prostate cancer and low testosterone levels may have a higher risk of their cancer progressing to a more aggressive form while under active surveillance.
The findings, published by Lawen et al in the The Journal of Urology, suggest that baseline testosterone may serve as a useful clinical marker to better stratify risk and tailor monitoring strategies for patients choosing active surveillance.
“Active surveillance is a safe and effective option for many men with early-stage prostate cancer. However, identifying which patients may be more likely to experience [disease] progression remains a key challenge,” said corresponding author Justin R. Gregg, MD, Associate Professor of Urology and Health Disparities Research at The University of Texas MD Anderson Cancer Center. “Understanding how hormonal factors influence prostate cancer biology may help us refine surveillance strategies.”
Active surveillance is recommended for patients with low-risk prostate cancer, allowing physicians to closely monitor the disease and delay or avoid treatment unless the cancer shows signs of becoming more aggressive.
In the retrospective cohort study, researchers analyzed clinical and pathologic data from more than 900 men undergoing surveillance. Researchers found that patients with prostate cancer with low baseline testosterone levels (300 ng/dL or lower) had a significantly higher likelihood of their cancer progressing to grade group 3 or higher (hazard ratio = 1.61, 95% confidence interval = 1.03–2.51, P = .04). The researchers also reported that low testosterone was not associated with risk of progression to grade group 2 disease or higher.
Low testosterone levels were associated with an increase in the likelihood of disease progression, even after accounting for other factors including age, prostate-specific antigen, body mass index, and tumor density and size.
The study does not suggest that low testosterone causes aggressive cancer, but rather that there is an association that could help guide monitoring and decision-making. Future studies are needed to confirm these findings and to determine if testosterone level may be a useful marker of future progression risk in individual patients.
The authors concluded, “These findings suggest that while low testosterone is not clearly associated with moderate progression (grade group 2), it may increase the risk of higher-grade ‘extreme’ progression to grade group 3 or higher. Future studies should focus on prospective validation of our findings to elucidate the biological relationship between androgens and prostate cancer progression.”
DISCLOSURE: For full disclosures of the study authors, visit auajournals.org.
