Low Testosterone May Signal Aggressive Prostate Cancer

Low levels of testosterone may indicate a worsening of low-risk prostate cancer for men with the disease, a new study finds.

Study authors say the findings may aid physicians in identifying low-risk prostate cancer patients who should receive aggressive anti-cancer treatment.
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Ignacio San Francisco, MD, and colleagues at the Pontifica Universidad Catolica de Chile followed 154 men with low-risk prostate cancer for 38 months, finding that low levels of free testosterone were significantly linked with an increased risk of developing more aggressive disease.

These results suggest low levels of testosterone are associated with more aggressive prostate cancer, according to lead study author San Francisco, who adds that the findings contradict long-held beliefs that high testosterone is dangerous for prostate cancer, while low testosterone is considered protective.  

In addition, the researchers found no substantial association with total testosterone concentrations, but indicated a general trend toward increased risk with lower levels, noting that free testosterone comprises 1 percent to 2 percent of total testosterone and is considered a “useful surrogate for the biologically active portion of circulating testosterone.”

According to San Francisco, the results provide “valuable information” to primary care physicians and their patients with regard to risk factors for prostate cancer progression in men undergoing active surveillance.

In borderline cases, he says, the presence of low values of free testosterone may help clinicians decide whether initiating treatment or continuing observation is the better option.

Patients initially diagnosed with low-risk prostate cancer may have an aggressive disease course “if they have low levels of free testosterone,” adds San Francisco. Therefore, for primary care physicians, “rapid referral [of these patients] to a urologist is fundamental.”

—Mark McGraw

Reference

San Francisco I, Rojas P, et al. Low free testosterone predicts disease reclassification in men with prostate cancer undergoing active surveillance. BJU International. 2014.