Testosterone at diagnosis

[pjoshea13]

This is prompted by the recent post by martingugino.

He "asked {his} hospital a question: 'In prostate cancer, is there a correlation between testosterone levels at diagnosis and Gleason score.'"

& received the expected answer "no correlation".

The people at the hospital would not be expected to have the hands-on experience to give an expert opinion, since testosterone [T] is not generally measured around the time of diagnosis.

(For the people who still believe that T drives PCa, "no correlation" must be a disappointing response.)

To answer the question, one would have to look at studies that did measure T at the time of diagnosis. Here are 16 studies since 2010:

[1] (2016) "Preoperative PSA/{free testosterone} index ratio is an independent strong factor which directly associates with aggressive features of pathology PCA"

[2] (2016) "Men with hypogonadism and a clinical indication for biopsy often have prostate cancer, many high grade. No men with an initial PSA rise on TRT had cancer."

[3] (2015) "Low Serum Testosterone ... Predicts High Gleason Score at Biopsy Diagnosed as Prostate Cancer in Patients with Serum PSA Lower than 20 ng/ml."

[4] (2015) "Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading"

[5] (2016) "low serum testosterone (<3.0 ng ml-1 , adjusted OR, 8.52 ...) predicted {extra-prostatic extension}"

[6] (2015) "Our data suggest that only low {bioavailable testosterone} and {free testosterone} levels, which might logically result in an active androgen-depleted environment, were linked with high-grade PCa."

[7] (2013) "Preoperative {total testosterone} was {inversely} associated with extraprostatic disease and may become a useful tool to improve our ability to recognize more advanced carcinomas. ... the concept that testosterone and other androgens have a permissive role and promote the development of PCa seems to be incorrect and an oversimplification in view of the current evidences in the field."

[8] (2012) "Low pretreatment serum total testosterone is associated with a high incidence of Gleason score 8-10 disease in prostatectomy specimens"

[9] (2013) "Low pre-treatment fT levels were significantly associated with tumour stage and extraprostatic tumour spread and might-in addition or combination with PSA-serve as a useful prognostic parameter for prostate cancer patients prior to radical prostatectomy."

[10] (2012) "Association between low serum free testosterone and adverse prognostic factors in men diagnosed with prostate cancer"

[11] (2012) "Patients with PCa and lower testosterone levels have poor prognosis factors and higher tumour burden before treatment onset."

[12] (2011) "Lower serum total testosterone is associated with lymph node metastases in a radical prostatectomy cohort study."

[13] (2011) "High incidence of predominant Gleason pattern 4 localized prostate cancer is associated with low serum testosterone."

[14] (2011) "Low pretreatment serum testosterone levels correlate with a higher risk of {biochemical failure }"

[15] (2011) "Low serum testosterone appears to be predictive of aggressive disease (Gleason score >7 and extraprostatic disease, pathological stage > pT2) in patients who underwent RP for localized prostate cancer."

[16] (2010) "lower levels of {free testosterone} are detected in prostate cancer patients with extensive and high-grade disease."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/270...

[2] ncbi.nlm.nih.gov/pubmed/267...

[3] ncbi.nlm.nih.gov/pubmed/265...

[4] ncbi.nlm.nih.gov/pubmed/264...

[5] ncbi.nlm.nih.gov/pubmed/259...

[6] ncbi.nlm.nih.gov/pubmed/255...

[7] brazjurol.com.br/march_apri...

[8] ncbi.nlm.nih.gov/pubmed/229...

[9] ncbi.nlm.nih.gov/pubmed/227...

[10] ncbi.nlm.nih.gov/pubmed/226...

[11] ncbi.nlm.nih.gov/pubmed/225...

[12] ncbi.nlm.nih.gov/pubmed/219...

[13] ncbi.nlm.nih.gov/pubmed/218...

[14] "ncbi.nlm.nih.gov/pubmed/218...

[15] ncbi.nlm.nih.gov/pubmed/210...

[16] ncbi.nlm.nih.gov/pubmed/209...

[Sisira]

Wow!

What a complete and clear answer one can rarely find.

This is Patrick. It is an undisputable brand!

Many thanks

Sisira

[Neal-Snyder]

What Sisira said!

A cuppa T sounds awfully damn good right now!

Neal

[Hidden]

Correct. I did not have my testosterone level checked at diagnosis. They also did not do a baseline calcium or vitamin d or LDH or PAP. Maybe those are meaningless, but I just don't think so. PAP is important later on (say with Xofigo), And I thought I saw a slide (will look for it) that LDH was a kind of poor-man's CTC count.

[yope4]

I have a problem squaring low-T as predictive of high grade PCa and mets. My reason is met is treated with ADT that drives down T and PSA together. Is it possible that at diagnosis when correlation between high grade PCa and low_T were measured is because the PCa has used up available T driving it down. And that the PCa is not growing as fast compared to when T was higher. I mean we just have to be careful in suggesting low_T causes high grade PCa.

[pjoshea13 in reply to yope4]

For me, low T is about estrogen dominance. Estradiol [E2] is able to promote growth via its alpha receptor [ERalpha]. Low T is growth-permissive. Normal-high T resists aggressive growth.

One reason is that a protective metabolic pathway is:

T ---> DHT ---> 3-beta Adiol

youtube.com/watch?v=bA89enH...(Not working as expected?)

3-beta Adiol is the natural ligand of the beta estrogen receptor [ERbeta]. So it turns out, oddly, that a metabolite of the most powerful androgen, is an estrogen. ERbeta resists ERalpha. Which is why I believe that healthy T levels are protective.

& note: when T is low, E2 is usually high. The ratio is commonly altered in the metabolic syndrome [MetS]. Visceral fat secretes E2 & MetS is associated with increased visceral fat. When E2 is elevated, the body tries to correct the situation by cutting down on T production.

-Patrick

[Daddyishealing in reply to pjoshea13]

Ty this seems quite logical

[sbmurray]

That was really interesting. I thought it was the other way around. Good explanations. Thanks for the info.

[Hidden]

Wow, is right, thanks for this info, Patrick. Now, I'm curious as to why, after you get fingered six times, and you know you have BHP at least, do they not do both tests, PSA and T. All these references about it, you would think it would be more popular.

Joe

[Ralph1966]

What about estrogen level (estradiol)? Should it be higher than normal limits for men, so low Testesteron with high estrogen can cause higher G score? Even normal T level but 300 or less is considered low? My last T level is 280 (March 2019)down from 320 6 months ago. My G score is 4+5.

Why MO don't try to correct this hormonal imbalance to improve the treatment results?

[pjoshea13 in reply to Ralph1966]

I think there is fear of departing from normal protocols. The doctor may not believe that T is "gasoline" to PCa - but why take the chance? As to estradiol [E2], too many believe that it is a female hormone & therefore irrelevant to the prostate. IMO

-Patrick

[Ralph1966]

BTW, my Aux PET scan showed gynecomastia (enlarged breasts) although it is not visible, and yet the MO didn't even discussed that in my Second visit. E2 can cause this condition among other causes (I am taking Losartan 50 mg OD for HTN). I am thinking to ask my primary physician to do blood test for E2 or may be go to endocrinologest to check this. Nal, I read that you do test your E2 level besides tT and free Testesteton?