Hypogonadism Ups Progression Risk in Men With Low-Risk PCa
New findings have potential implications regarding patient selection for active surveillance.
Hypogonadism in prostate cancer (PCa) patients eligible for active surveillance (AS) is associated with an elevated risk of disease progression, according to researchers.
In a study of 338 PCa patients who met AS criteria but opted to undergo radical prostatectomy, Matteo Ferro, MD, of the European Institute of Oncology in Milan, Italy, and colleagues found that hypogonadism (defined as a serum testosterone level below 300 ng/dL) was significantly associated with a greater likelihood of upgrading, upstaging, unfavorable disease (occurrence of pathologic stage greater than pT2 and predominant Gleason score 4), and positive surgical margins (PSM).
Compared with a testosterone level of 300 ng/dL or higher, a level below 300 ng/dL was associated with a significant 11.6-fold increased odds of upstaging, 3.6-fold increased odds of upgrading, 10-fold increased odds of unfavorable disease, 2.2-fold increased odds of PSM, and 6.7-fold increased odds of predominant Gleason 4 disease, Dr Ferro's group reported online in Oncotarget. Each 10 ng/dL increment in testosterone was associated with a significant 8% decrease in the odds of upstaging, 3% decreased odds of upgrading, 7% decreased odds of unfavorable disease, and 4% decreased odds of predominant Gleason 4 disease.
Hypogonadism showed 65% sensitivity and 92% specificity for upstaging, 34% sensitivity and 92% specificity for upgrading, 85% sensitivity and 82% specificity for unfavorable disease, and 52% sensitivity and 88% specificity for predominant Gleason 4 disease.
The addition of testosterone to a base model that includes age, PSA, PSA density, clinical stage, and positive cancer involvement in cores improved predictive accuracy, according to the investigators.
Dr Ferro and his colleagues concluded that their results support the idea that total testosterone should be a selection criterion for inclusion of low-risk PCa patients in AS programs and suggest that a testosterone level below 300 ng/dL should be considered a discouraging factor when considering AS.
1. Ferro M et al. Low serum testosterone level as a predictor of upstaging and upgrading in low-risk prostate cancer patients meeting the inclusion criteria for active surveillance. Oncotarget 2016; published online ahead of print.