Low baseline testosterone and link to overall survival in advanced prostate cancer.

[SherryKahn]

My husband’s baseline testosterone levels came back at 202. Is there a correlation between low baseline testosterone and overall survival after treatment for advanced prostate cancer? There seem to be inconclusive studies and often opposite results on the topic. So any insight would be appreciated.

[Lost_Sheep]

I know of one study finding that lowering the definition of "castrate level testosterone" from 50 ng/dl to 20 ng/dl increases the time to developing castrate resistance 1.9 fold.

ncbi.nlm.nih.gov/pmc/articl...

That says nothing about pre-treatment or baseline T levels and survival, though.

[MikeUSNA64]

FROM CHAT GPT: Yes, there is a correlation between low baseline testosterone levels and overall survival after treatment for advanced prostate cancer. Several studies have investigated the impact of baseline testosterone levels on the prognosis of prostate cancer patients, particularly those undergoing androgen deprivation therapy (ADT) or other treatments for advanced disease.

Key Findings from Research

Prognostic Marker:

Studies suggest that low baseline testosterone levels can be associated with poorer outcomes in patients with advanced prostate cancer. For instance, one study found that lower baseline testosterone was linked to shorter overall survival and progression-free survival in patients receiving ADT for metastatic prostate cancer .

Disease Progression:

Research indicates that men with lower baseline testosterone levels might experience more aggressive disease and faster progression. This could be due to the fact that lower testosterone levels at baseline might reflect a more advanced disease state or a more compromised health status overall .

Treatment Response:

Testosterone levels can influence the response to ADT. Patients with lower baseline levels might not respond as robustly to hormone therapy, impacting their overall survival and quality of life during treatment .

Clinical Implications

Risk Stratification: Baseline testosterone levels can be used as part of risk stratification models to better predict patient outcomes and tailor treatment plans accordingly.

Monitoring and Management: Regular monitoring of testosterone levels before and during treatment can help in managing the disease more effectively and potentially adjusting therapeutic approaches.

Recommendations

Consultation with Specialists: It's crucial to discuss the implications of low baseline testosterone levels with oncologists and endocrinologists who can provide personalized insights and recommendations.

Holistic Approach: Consider comprehensive management strategies that address not just the cancer itself but also overall hormonal health, nutritional status, and other factors that can influence outcomes.

Sources

National Institutes of Health (NIH): Impact of Baseline Testosterone on Prognosis

Journal of Clinical Oncology: Testosterone Levels and Prostate Cancer Outcomes

European Urology: Role of Testosterone in Prostate Cancer Management

By understanding the correlation between baseline testosterone levels and prostate cancer outcomes, patients and healthcare providers can better navigate treatment decisions and expectations.

[TommyCarz2]

If I understand correctly, if testosterone is low at diagnosis, it's likely because the cancer is more advanced. Prostate cancer feeds on testosterone, as it does this, it depletes the body's "natural" testosterone. Now, of course the drugs that we take also deplete our testosterone levels to "starve" the cancer. For about 2 years or so BEFORE I was diagnosed with stage 4 metastatic, Grade 5 Gleason score 9, prostate cancer, I would experience intense "Hot Flashes" , and I had no idea why. But now that I've learned about the changes that take place our bodies because of low T levels, it all makes sense. So, I don't know , other than my own experience, what low T at diagnosis means, other than the cancer is likely to be more advanced than one might think.

[SteveTheJ]

My (mis)understanding is that testosterone of 200 is normal. I don't know what "baseline" testosterone is though.

[Mgtd in reply to SteveTheJ]

Steve as I understand the term it means what is normal for each individual prior to say using ADT. In my case my baseline T was around 700 and while on ADT it was suppressed to <12.

None of my doctors were really interested in my T level but I surely was. It effected the QOL.

[Roxysdad in reply to Mgtd]

You nailed it!…with .12 T level (mine was the same) QOL is out the window…No energy, no libido, no nada….I never felt better when I was on BAT….

[janebob99]

There are associations between low testosterone and worse prostate cancer. Attached is one example from Atkins et al. (2018)

pubmed.ncbi.nlm.nih.gov/292...

This study reports that the percent Prostate Cancer Specific Mortality was much worse for men with low testosterone, compared to men with normal testosterone. From the Conclusions:

"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."

You also may want to Google the 150+ papers written by A. Morgentaler from Harvard about this topic.

Finally, if you send me a request to my email: [e-mail], I will send you additional information that you may find useful.

Bob in New Mexico

Influence of Low Testosterone on Mortality

[Mgtd in reply to janebob99]

Bob what is the red line?

[janebob99 in reply to Mgtd]

In this plot, the red line is the risk of dying (ranging from 0-100% risk) from prostate cancer versus # of years after the PSA has risen from a nadir level to greater than 2.0 (i.e., "PSA Failure", for castrate-resistant men), for men with low testosterone (i.e., median = 162 ng/dl). For example, at 5 years following PSA Failure, the risk of dying is 60% for men with low testosterone, compared to a risk of dying of only 6% for men with normal testosterone (400-750 ng/dl), at 5 years. That's a 10-fold increase in the mortality risk if you have low testosterone (for castrate-resistant men).

The opposite is true for hormone-sensitive men. In that regime, having a low testosterone is desirable (i.e., protective). That's the basis of ADT.

[Mascouche in reply to janebob99]

"PSA Failure" is confusing. Wouldn't the term "PCA Recurrence" be a better fit for that that of graph?

[SherryKahn in reply to janebob99]

If I read this correctly the baseline T in this study is after psa castration failure so not prior to any treatment.

[janebob99 in reply to SherryKahn]

Yes, you are correct.

If, however, you are interested in what the effect testosterone has on the odds of getting PCa in the first place, then read this paper by Tu et al. (2017):

spandidos-publications.com/...

This plot from Tu's paper shows the odds of either getting intermediate-risk PCa or high-risk/metatastic PCa verses total testosterone levels. Both plots show that the lower your testosterone is, the greater the odds of getting prostate cancer initially. The plot also shows that high levels of testosterone is protective against initially getting PCa .

Bob in New Mexico

Odds Ratio vs Testosterone

[Mgtd in reply to janebob99]

Thank you. Great explanation! I just realized if I had clicked on the magnifying glass I would not of had to ask the question. Thanks for taking the time to answer. It was greatly appreciated.

[janebob99 in reply to Mgtd]

You're Welcome !

[j-o-h-n]

Well Sherry, It's nice to see that you now refer to your Partner as your Husband. Congratulations.

Good Luck, Good Health and Good Humor.

j-o-h-n

[SherryKahn in reply to j-o-h-n]

It depends …. on days he doesn’t behave he is neither!

[j-o-h-n]

A three letter word for little boys: MEN

Good Luck, Good Health and Good Humor.

j-o-h-n