AUA 2019: Low Free Testosterone {FT} is an Independent Risk Factor for High Grade Prostate Cancer

[pjoshea13]

"men with low FT generally had aggressive, high grade cancers. Additionally, higher FT was protective of negative oncologic outcomes, which Towe mentions was first presented by Dr. Morgentaler in the 1990s."

-Patrick

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AUA 2019: Low Free Testosterone is an Independent Risk Factor for High Grade Prostate Cancer

Chicago, IL (UroToday.com) Maxwell Towe, research fellow from UC Irvine presented on the relationship between free testosterone and prostate cancer tumor growth. Towe and his co-authors sought to analyze whether free testosterone (and not total testosterone) could predict aggressiveness in prostate cancers. While it is still a controversial topic, more recent studies have found that low testosterone is linked to decreased oncologic outcomes.

The study included 830 patients undergoing robot assisted radical prostatectomy (RARP) and were divided into quartiles based on FT. They surveyed Gleason grade prevalence across the FT quartile groups, and results showed a trend indicating that with decrease in free testosterone there was an increase in very high grade prostate cancer. This relationship was most prevalent between the lowest (≤ 4.42 ng/dL) and highest (≥ 6.96 ng/dL) FT quartiles, with a difference in Gleason grade group 5 of 15.6% and 6.2% (p=0.002), respectively. Additionally, multivariate analysis showed that lower FT was a significant predictor of high-risk score 9-10 (OR:0.912, p=0.036).

In conclusion, men with low FT generally had aggressive, high grade cancers. Additionally, higher FT was protective of negative oncologic outcomes, which Towe mentions was first presented by Dr. Morgentaler in the 1990s. Lastly, Towe stressed that free and total testosterone levels should be assesses in all men with prostate cancer. The teams work encourages future studies on testosterone replacement therapy benefits on prostate cancer.

Presented by: Maxwell M Towe, Linda M Huynh, Farouk M El-Khatib, Mohamad M Osman, Faysal Yafi, Thomas E Ahlering, University of California, Irvine, CA

Written by: Kaelyn See, Department of Urology, University of California-Irvine, at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois

[Garp41]

PJ,

Do you think this because free T is protective, or because the PCa is utilizing the free T to grow?

Doug

[pjoshea13 in reply to Garp41]

When we were young, our steroid hormones were largely in balance. That continued for several decades for many of us. & how many of us needed a urologist back then?

Testosterone plays an important regulatory role in prostate homeostasis. It is necessary for cell division, but its presence does not make cell division obligatory.

Testosterone [T] inexorably falls by 1-2% / year & PCa emerges when T is much diminished. (For many, estradiol [E2] has also increased over the years.) In my opinion, low T is growth-permissive - & has lost its ability to control growth.

Free T is the best measure of bioactive T. Perhaps 98% of total T is bound to proteins. Total T is not a good surrogate for free T levels, since some men have high levels of the SHBG binding protein.

More important than using PSA to detect PCa, would be to use free T to detect those at risk, IMO. Intervention to prevent PCa (T supplementation) might dramatically cut PCa cases down.

-Patrick

[Jbooml in reply to pjoshea13]

I've had the hunch that the lack of free T synchronous with elevated estradiol is the recipe for PC promotion.

Just my intuition

I wish I knew what I believe now to test that theory...I was like a lot of other sufferers deaf dumb and blind to what incipiently lurks below the belt.

[Fairwind]

Maybe that's why BAT works so well for some stage 4 PC guys...It's pathetic you must be accepted into a trial or DIY to try this treatment...