I continue to see comments about testosterone [T] driving PCa, so I post contrarian studies as they turn up. This is not cherry picking, since high-normal T has never been associated with risk, compared to low-normal T.
"We retrospectively reviewed 92 patients with benign prostatic hyperplasia (BPH) and 164 patients with PCa treated at Zhongshan Hospital, China (April 2012 to November 2013)."
Patients with PCa and PSA >20 ng/ml had lower testosterone (12.9 versus 17.5 ng/ml).
Patients with PCa and PSA >20 ng/ml had lower T/PSA (0.29 versus 2.24).
Patients with PCa and Gleason score >7 had lower testosterone (14.1 versus 18.3 ng/ml).
In patients with PSA ≤20 ng/ml, T/PSA was lower in those with PCa than in those with BPH (2.24 versus 4.69).
"T/PSA may improve the accuracy of PCa diagnosis in patients with a PSA level ≤20 ng/ml."
We investigated whether serum testosterone and testosterone/prostate-specific antigen ratio (T/PSA) might be prostate cancer (PCa) biomarkers. We retrospectively reviewed 92 patients with benign prostatic hyperplasia (BPH) and 164 patients with PCa treated at Zhongshan Hospital, China (April 2012 to November 2013). The BPH and PCa groups had similar serum total testosterone (median, 15.8 versus 16.3 nmol/L).Compared with the BPH group, the PCa group had higher PSA (16.8 versus 5.1 ng/ml) and lower free/total PSA (9.5% versus 19.3%) and T/PSA (1.37 versus 4.69) (all p < .001).Patients with PCa and PSA ≤20 ng/ml had higher testosterone (17.5 versus 12.9 ng/ml; p = .002) and T/PSA (2.24 versus 0.29; p < .001) than those with PSA >20 ng/ml. Patients with PCa and Gleason score ≤7 had higher testosterone (18.3 versus 14.1 ng/ml; p = .023) and T/PSA (1.93 versus 0.72; p < .001) than those with Gleason score >7. In patients with PSA ≤20 ng/ml, T/PSA was higher in those with BPH than in those with PCa (4.69 versus 2.24; p < .001). ROC curve analysis yielded an AUC of 0.712; for the optimal cut-off of 4.43, specificity and sensitivity were 52% and 97% respectively. T/PSA may improve the accuracy of PCa diagnosis in patients with a PSA level ≤20 ng/ml.
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pjoshea13
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There may be a link between T and PCa but it may have a very long time lag.
By that I mean that the T levels in early life, during adolescent, and during early adult years, may be more important than those levels in the decade when the PCa is first diagnosed.
Although the prostate cancer literature has shown that current testosterone level at the time of diagnosis does not correlate closely with diagnosis or cancer grade and stage, there are a handful of "facts" which hint that testosterone levels some decades earlier are important.
Here are some of those "facts":
1.Prostate cancer patients tend to be on average a bit taller than age matched men without that diagnosis. Height correlated with testosterone levels during development).
2.If I recall correctly from a few years, back, two out of three 2D:4D papers on prostate cancer patients suggest that they had high exposure to testosterone during development.
3.Some studies on male patterns of balding also suggest high testosterone exposure in the decades previous to a prostate cancer diagnosis.
4.One study out of Scandinavia found a correlation of prostate cancer with divorce rates. Higher divorce rates in men with prostate cancer. Men, who are high in testosterone, are less likely to maintain single stable relationships thus they maybe more likely to get divorced.
5.Prostate cancer in the early stages is very slow growing and may take decades to evolve into a clinical conspicuous and dangerous disease. Data from the gross anomy lab shows that men—if they live past 75—will have prostate cancer that was never be problematic or even diagnosed. The slow growth suggests why the testosterone levels early may be better correlated with prostate cancer emergence than more immediate testosterone levels.
By the way, I've never seen all the points listed about laid out in any single systematic review, nor do I have the time and energy to dig out the references to back this up. But, if someone is really interested in exploring these speculations further, I'd be happy to encourage the investigation. [Patrick you know and clearly like rooting around in PubMed.]
Hi Richard, What country do you live in? I would like to call you sometime and pick your brain. I am in Thailand at the moment; however, I am leaving for CA on August 5 to have robotic surgery on lymph node mets along my sacral vertebrae. My doc is hoping to postpone putting me on ADT. The 68Ga scan that I recently had performed in Australia identified only LN involvement. No bone mets were found; however, I am somewhat concerned since my alkaline phosphatase level is at the top of the range for a 75 year old man: 114 (the range that the hospital used was a max of 115). Thanks for your previous replies. Kind regards, Ron
Before you give any credence to this study, please research the average PSA for Asians as it is quite a bit lower for men in the Western World. Genetics? Probably. I had this discussion with an Urologist in Japan who studied at Johns Hopkin 17 years ago.
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