New study below.
When I started reviewing PCa literature 13 years ago, there wasn't much about testosterone [T]. However, (& my wife still remembers my surprise), normal T levels were not implicated in PCa occurrence or aggressive disease.
Low T, which I tend to think of in terms of estrogen dominance, was growth-permissive.
T below Morgentaler's 'saturation' point - where there is not enough T to bind to every androgen receptor [AR] offers some protection. i.e. partial castration.
None of the studies published in the past 13 years have changed the view that it unsafe to be at the high end of hypogonadal, or the very low end of "normal".
The current study (Dana-Farber, Sloan Kettering, etc, etc.) suffers from the fact that doctors are not interested in T unless they are trying to suppress it. & so we only have "a total of 58 men with unfavorable-risk PC who were treated on clinical trials with radiotherapy and androgen deprivation therapy (ADT) {who} had available testosterone levels at the time of PSA failure."
"After a median follow-up of 6.68 years after PSA failure, 31 men (53.4%) had died; 10 of PC (32.3%), of which 8 of 11 (72.7%) versus 2 of 47 (4.3%) deaths occurred in men with low versus normal testosterone at the time of PSA failure, respectively.
"Low, but not necessarily castrate, testosterone levels at the time of PSA failure confer a very poor prognosis."
"These observations provide evidence to support testosterone testing at the time of PSA failure." Well, perhaps a bit late for that, but with a poorer prognosis, a more aggressive treatment seems warranted.
-Patrick
ncbi.nlm.nih.gov/pubmed/292...
Cancer. 2017 Dec 20. doi: 10.1002/cncr.31204. [Epub ahead of print]
Low testosterone at first prostate-specific antigen failure and assessment of risk of death in men with unfavorable-risk prostate cancer treated on prospective clinical trials.
Atkins KM1, Chen MH2, Wu J3, Renshaw AA4, Loffredo M5, Kantoff PW6, Small EJ7, D'Amico AV5.
Author information
1
Harvard Radiation Oncology Program, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts.
2
Department of Statistics, University of Connecticut, Storrs, Connecticut.
3
Department of Computer Science and Statistics, University of Rhode Island, Kingston, Rhode Island.
4
Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida.
5
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts.
6
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
7
Department of Medicine, University of California at San Francisco, San Francisco, California.
Abstract
BACKGROUND:
Low testosterone at the time of diagnosis of prostate cancer has been associated with a worse prognosis. Whether this is true and how to define the best treatment approach at the time of first prostate-specific antigen (PSA) failure to the authors' knowledge has not been elucidated to date and was studied herein.
METHODS:
Between 1995 and 2001, a total of 58 men with unfavorable-risk PC who were treated on clinical trials with radiotherapy and androgen deprivation therapy (ADT) had available testosterone levels at the time of PSA failure. Cox and Fine and Gray regressions were performed to ascertain whether low versus normal testosterone was associated with the risk of PC-specific mortality, other-cause mortality, and all-cause mortality adjusting for age, salvage ADT, and known PC prognostic factors.
RESULTS:
After a median follow-up of 6.68 years after PSA failure, 31 men (53.4%) had died; 10 of PC (32.3%), of which 8 of 11 (72.7%) versus 2 of 47 (4.3%) deaths occurred in men with low versus normal testosterone at the time of PSA failure, respectively. A significant increase in the risk of all-cause mortality (adjusted hazard ratio [AHR], 2.54; 95% confidence interval [95% CI], 1.04-6.21 [P = .04]) and PC-specific mortality (AHR, 13.71; 95% CI, 2.4-78.16 [P = .003]), with a reciprocal trend toward a decreased risk of other-cause mortality (AHR, 0.18; 95% CI, 0.02-1.55 [P = .12]) was observed in men with low versus normal testosterone.
CONCLUSIONS:
Low, but not necessarily castrate, testosterone levels at the time of PSA failure confer a very poor prognosis. These observations provide evidence to support testosterone testing at the time of PSA failure. Given prolonged survival when abiraterone or docetaxel is added to ADT in men with castrate-sensitive metastatic PC and possibly localized high-risk PC provides a rationale supporting their use with ADT in men with low testosterone in the setting of a phase 2 trial. Cancer 2017. © 2017 American Cancer Society.
© 2017 American Cancer Society.
KEYWORDS:
biochemical failure; death; prostate cancer; prostate-specific antigen (PSA) failure; testosterone
PMID: 29266181 DOI: 10.1002/cncr.31204
High Gleason low PSA - quit ADT? 
Effect of low endogenous testosterone
