Low testosterone levels prior to radical prostatectomy (RP) for prostate cancer (PCa) are associated with worse oncologic outcomes, new findings suggest.

In a study of 177 men who had their preoperative testosterone levels measured and underwent RP, a team led by R. Jeffrey Karnes, MD, of Mayo Clinic in Rochester, Minn., found that patients with a low preoperative testosterone level (below 300 ng/dL) had a significantly higher risk of positive surgical margins and seminal vesicle invasion compared with men who had normal testosterone levels before surgery

Low testosterone was associated with a slightly, but not significantly, higher rate of biochemical failure, the investigators reported in the Journal of Men’s Health (2014;10:129-133).

Patients had a median preoperative testosterone level of 423 ng/dL  and a median age of 65 years. Of the 177 patients, 40 had low and 137 had normal testosterone. The study had a median follow-up of about 15 years, making it the longest follow-up to date correlating preoperative testosterone levels with biochemical failure in men undergoing RP, the researchers noted.


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Positive surgical margins and seminal vesicle invasion were found in 47.5% and 22.5%, respectively, of the low testosterone group compared with 29.9% and 8%, respectively, of the normal testosterone group.

“The data add to the accumulating evidence that low testosterone levels could potentially be an adverse factor in prostate cancer patients,” Dr. Karnes’ group concluded.