ORLANDO, FL USA (UroToday.com) - Prostate specific antigen (PSA) lacks many qualities of an ideal testing marker. That said, it can be difficult to escape its application when evaluating males for prostate cancer, and it has some proven utility in treatment decisions. Work in recent years has focused on bolstering the utility of PSA through the use of additional measures, or adjusting its use and how it's reported. In this study, Neuzillet and colleagues report on a prospective study evaluating the association of total testosterone with prostate cancer aggressiveness. The aggressiveness of the cancer was measured using predominant Gleason pattern.
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It was performed over approximately 2.5 years for patients referred for radical prostatectomy. The biopsy and tissue specimens were analyzed by two uropathologists. A total of 937 patients were enrolled. Of these, 139 with total testosterone (TT) < 3.0 ng/mL had a higher mean weight and BMI than the rest of the cohort (p < 0.001 for both). They observed a predominant Gleason pattern of 4 (prdGP4) in 169 (18%) of patient biopsies and 290 (31%) of prostate specimens after prostatectomy. They found that patients with prdGP4 had a lower TT when compared to patients with prdGP3 (4.4 vs 4.7 ng/mL, p=0.017) and had a higher PSA (10.2 vs 7.7 ng/mL, p < 0.001). Additionally, they observed extraprostatic extension and positive margins more often in the cohort of patients with prdGP4 (55% versus 23%, p < 0.0001).
These results implicate that the TT has a strong association with prdGP4, which cannot be accurately measured using prostate biopsy. Thus, TT may be useful in adjusting PSA and biopsy results to inform a more detailed and specific decision algorithm. Development and validation of such a decision instrument is an interesting hopeful future for this work. However, additional studies regarding the predictive validity of TT and further studies on the measure would be necessary before such an instrument could be implemented and evaluated.
Presented by Yann Neuzillet at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
Written by Martin Hofmann, MD, University of California (Irvine), and medical writer for UroToday.com