Is baseline free serum T a factor in appropriate management on active surveillance?


Analysis of data from a cohort of 154 Chilean men with prostate cancer, all being monitored on active surveillance, suggests that free serum testosterone levels (but not total testosterone levels) may be able to help to predict which of these men will go on to need active treatment.

San Francisco et al. determined the total and the free serum testosterone concentrations of all the patients in this cohort of men when they were initially entered on the active surveillance protocol.

Here are their findings, as reported in BJU International earlier this year:

  • 54/154 men (35 percent) progressed to having active treatment.
  • On average, the patients who had disease reclassification had lower free testosterone levels than those who were not reclassified (0.75 vs 1.02 ng/dl, P = 0.03).
  • Men with free testosterone levels < 0.45 ng/dl had a higher rate of disease reclassification than patients with free testosterone levels ≥ 0.45 (P = 0.032).
  • Free testosterone levels < 0.45 ng/dl were associated with major increase in risk for disease reclassification (odds ratio [OR] = 4.3).
  • Free serum testosterone levels and family history of prostate cancer were independent predictors of risk for disease reclassification.

The authors conclude that:

  • Free testosterone levels were lower in men with prostate cancer who had reclassification while on active surveillance.
  • Men with “moderately severe reductions” in free testosterone level were at an increased risk for disease reclassification.

As far as The “New” Prostate Cancer InfoLink is aware, this is the first report of an association between free serum testosterone level and risk for clinically significant prostate cancer in men on active surveillance. And the abstract tells us nothing about the original criteria used for entry into the active surveillance protocol for this cohort of patients, or the criteria for reclassification into an active treatment category.

If these or comparable data can be reproduced in other series of men on active surveillance, then it would appear to suggest that a baseline free serum testosterone level (and perhaps regular checks on free serum testosterone) would need to be a critical factor in the management of patients on active surveillance.

6 Responses

  1. Bingo!! Dr Morgenthaler and I are smiling very widely. … :-)

  2. Walt … We’re gonna need more than one swallow to make a summer!

  3. I think the future looks bright. :)

  4. Can anyone say “RCT”?

  5. Yeah, I can say it, but what does it mean? ;-)

  6. “Randomized controlled trial” … although actually I think all we need is a larger, prospective database.

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