AUA 2019: Low Free Testosterone is an Independent Risk Factor for High Grade Prostate Cancer

Chicago, IL (UroToday.com) Maxwell Towe, research fellow from UC Irvine presented on the relationship between free testosterone and prostate cancer tumor growth. Towe and his co-authors sought to analyze whether free testosterone (and not total testosterone) could predict aggressiveness in prostate cancers. While it is still a controversial topic, more recent studies have found that low testosterone is linked to decreased oncologic outcomes. 


The study included 830 patients undergoing robot assisted radical prostatectomy (RARP) and were divided into quartiles based on FT. They surveyed Gleason grade prevalence across the FT quartile groups, and results showed a trend indicating that with decrease in free testosterone there was an increase in very high grade prostate cancer. This relationship was most prevalent between the lowest (≤ 4.42 ng/dL) and highest (≥ 6.96 ng/dL) FT quartiles, with a difference in Gleason grade group 5 of 15.6% and 6.2% (p=0.002), respectively. Additionally, multivariate analysis showed that lower FT was a significant predictor of high-risk score 9-10 (OR:0.912, p=0.036).

In conclusion, men with low FT generally had aggressive, high grade cancers. Additionally, higher FT was protective of negative oncologic outcomes, which Towe mentions was first presented by Dr. Morgentaler in the 1990s. Lastly, Towe stressed that free and total testosterone levels should be assesses in all men with prostate cancer. The teams work encourages future studies on testosterone replacement therapy benefits on prostate cancer. 

Presented by: Maxwell M Towe, Linda M Huynh, Farouk M El-Khatib, Mohamad M Osman, Faysal Yafi, Thomas E Ahlering, University of California, Irvine, CA

Written by: Kaelyn See, Department of Urology, University of California-Irvine, at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois