Department of Urology, The Johns Hopkins University School of Medicine, The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, and National Institute on Ageing, Intramural Research Program, Baltimore, MD, USA.

To evaluate the relationship between testosterone levels and the development of high-risk prostate cancer, by prospectively examining serum androgen concentrations in a well-studied cohort, as the role of testosterone in prostate cancer progression is debated.

The study comprised 781 men in the Baltimore Longitudinal Study of Aging who had sex steroid measurements before a diagnosis of prostate cancer, or at their last visit for those without cancer (no cancer, 636; cancer, not high risk, 109; cancer, high risk, 36). High-risk cancer was defined as death from prostate cancer, a prostate specific antigen (PSA) level of >/=20 ng/mL at diagnosis, or a Gleason score of >/=8. The hazard ratio (HR) of high-risk disease was determined using a Cox proportional hazards regression model with simple updating, and risk rates were stratified by age and tercile for androgens of interest based on the proportional hazards analyses.

The likelihood of high-risk prostate cancer doubled per unit (0.1) increase in the free testosterone index (FTI) for patients aged >65 years (HR 2.07, 95% confidence interval, CI, 1.01-4.23; P = 0.047); the likelihood for men aged < /=65 years was inversely related to the FTI (HR 0.96, 95% CI 0.35-2.6; P = 0.9). The risk rate per person-years increased from lowest to highest tercile of FTI for the oldest men (age >70 years) but this trend was not apparent among younger men.

Higher levels of serum free testosterone are associated with an increased risk of aggressive prostate cancer among older men. These data highlight the importance of prospective trials to insure the safety of testosterone-replacement therapy.

Written by:
Pierorazio PM, Ferrucci L, Kettermann A, Longo DL, Metter EJ, Carter HB.   Are you the author?

Reference:
BJU Int. 2009 Sep 14. Epub ahead of print.
doi:10.1111/j.1464-410X.2009.08853.x

PubMed Abstract
PMID:19751256

UroToday.com Prostate Cancer Section