Hypogonadism & upgrading of low-risk PCa.

[pjoshea13]

New meta-analysis below [1].

By now, the association of low testoterone with more serious PCa has been established IMO. (But I continue to post on such to counter the old "fuel on the fire" belief.)

Upgrading means that the pathologist, after radical prostatectomy [RP], found more serious cancer than the biopsy that prompted the RP.

It is not unusual for PCa to be regraded following surgery. Mostly up a GS notch, but occasionally down. After all, the biopsy is only a sample. But the study found that:

"low serum total testosterone is associated with a high rate of Gleason score upgrading in prostate cancer patients after RP." Low T increased the proability by a factor of 2.3. We wouldn't expect that if the delay from biopsy to surgery had little consequence on the state of the cancer. So perhaps that suggests that the cancer had a higher proliferation rate?

"Five studies comprising 1,203 low-risk prostate cancer patients were included."

"Low serum total testosterone" was defined as "<300 ng/dL)" - an old cut-off for hypogonadism (350 ng/dL is now more common).

"Low-risk" isn't defined in the Abstract. Gleason score [GS] 3.3 (& 3.4?) Alternatively, not high-risk GS [8-10]?

Anyway, adds to my feeling that men on active surveillance should undergo T replacement if T <500 ng/dL, say.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/356...

Investig Clin Urol

. 2022 May 25. doi: 10.4111/icu.20210459. Online ahead of print.

Low serum total testosterone level as a predictor of upgrading in low-risk prostate cancer patients after radical prostatectomy: A systematic review and meta-analysis

Shu Gan # 1 , Jian Liu # 2 , Zhiqiang Chen 1 , Songtao Xiang 1 , Chiming Gu 1 , Siyi Li 1 , Shusheng Wang 3

Affiliations collapse

Affiliations

1 Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.

2 Department of Urology, The Xinfeng County People's Hospital of Jiangxi Province, Jiangxi, China.

3 Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China. [e-mail].

# Contributed equally.

PMID: 35670005 DOI: 10.4111/icu.20210459

Abstract

Purpose: To investigated the association between serum total testosterone and Gleason score upgrading of low-risk prostate cancer after radical prostatectomy (RP).

Materials and methods: Medline, Web of Science, Embase, and Cochrane Library databases were searched to identify eligible studies published before October 2021. Multivariate adjusted odds ratios (ORs) and associated 95% confidence intervals (CIs) were calculated using random or fixed effects models.

Results: Five studies comprising 1,203 low-risk prostate cancer patients were included. The results showed that low serum total testosterone (<300 ng/dL) is associated with a high rate of Gleason score upgrading after RP (OR, 2.3; 95% CI, 1.38-3.83; p<0.001; I², 92.2%). Notably, sensitivity and meta-regression analyses further strengthen the reliability of our results.

Conclusions: Our results support the idea that low serum total testosterone is associated with a high rate of Gleason score upgrading in prostate cancer patients after RP. It is beneficial for urologist to ensure close monitoring of prostate-specific antigen levels and imaging examination when choosing non-RP treatment for low-risk prostate cancer patients.

Keywords: Meta-analysis; Prostatectomy; Prostatic neoplasms; Testosterone.

© The Korean Urological Association.

[GreenStreet]

Really interesting. Thanks.