Low serum T and high-risk prostate cancer in Korean men

A group of Korean researchers have poublished data suggesting that — at least in Korean patients — there may be an association between having a low serum testosterone (serum T) level and diagnosis with high-grade prostate cancer. Whether such findings are applicable to men of other ethnicities is not known at this time.

The paper by Park et al. in BJU International (also discussed on line in Renal & Urology News) is based on a retrospective analysis of data from 681 patients, all of whom were give an initial, 12-core, TRUS-guided biopsy at the authors’ institution in Seoul.

They divided their patients into two groups: men with low serum T levels (< 300 ng/dl) and men with comparatively normal serum T levels (≥ 300 ng/dl). After making that distinction, here is a summary of what they found:

  • 86/681 men (12.6 percent) had low serum T levels.
  • 143/681 men (32.7 percent) had a biopsy that was positive for prostate cancer (of any grade)
  • 99/681 men (14.5 percent) had “high-grade” prostate cancer (which is not defined in detail in the abstract).
  • There were significant differences between the low and the normal serum T groups with respect to
    • Average (mean) age
    • PSA level and PSA density
    • Body mass index (BMI)
    • Number of abnormal DRE findings
    • History of  diabetes mellitus
  • Compared to men in the normal serum T group, men in the low serum T group were
    • At higher risk of detection of prostate cancer or any grade and risk level on univariate analysis (odds ratio [OR] = 2.545, P = 0.001)
    • Not at higher risk of detection of prostate cancer of any grade and risk level on multivariate analysis (OR = 1.583, P = 0.277)
    • At higher risk of detection of high-grade prostate cancer on univariate analysis (OR = 3.324, P < 0.001)
    • At higher risk of detection of high-grade prostate cancer on multivariate analysis (OR = 2.138, P = 0.035)

Park et al. conclude that:

Low testosterone level is an independent risk factor for high-grade prostate cancer detection at biopsy. Therefore, checking testosterone levels could help to determine whether prostate biopsy should be carried out.

It would probably not be appropriate to apply this recommendation to patients of other ethnic populations unless and until such findings can be confirmed in those populations (e.g., Caucasian Americans, African Americans, Japanese, etc.). We would also note that these data come from a relatively small number of patients and probably need independent confirmation even in Korean patients.

8 Responses

  1. Extremely interesting! My guess is that advancing science will discover this to the the case, that aside from all the other health maladies that low T causes, there will be an established connection between low T and a higher incidence of prostate cancer.

  2. Walt:

    For years people thought that high serum T levels would be associated with heightened risk for prostate cancer. That proved to be untrue. My own suspicion is that the whole thing is a lot more complicated than serum T levels and has a great deal do with the biology of male development (going back into one’s teenage years and perhaps even younger).

  3. While the Baltimore Longitudinal Study of Aging (http://cebp.aacrjournals.org/content/14/9/2257.long) showed an association in the other direction, several studies from disparate places around the world showed that hypogonadal men are at increased risk for incidence and for more aggressive prostate cancer. Here are a few:
    Boston, MA (http://www.jurology.com/article/S0022-5347(05)67812-3/abstract)
    Brazil (http://www.goldjournal.net/article/S0090-4295(06)01962-5/abstract)
    Spain (http://informahealthcare.com/doi/abs/10.3109/00365599.2012.747562)
    France (http://www.urologiconcology.org/article/S1078-1439(14)00399-8/abstract)
    France (http://meeting.ascopubs.org/cgi/content/abstract/28/15_suppl/e15005)
    South Africa (http://www.ncbi.nlm.nih.gov/pubmed/22622101)

  4. Yes … But all these studies are small, retrospective in nature, and often published by physicians who have an axe in the game that they want to grind.

    I’d feel a lot better about all this if we saw a larger study from a group with a higher level of “street cred”.

  5. 5-Alpha reductase inhibitors (5-ARIs) like Proscar and Avodart may increase risk for high-grade prostate cancer. 5-ARIs suppress serum dihydrotestosterone (DHT) levels by inhibiting conversion of testosterone to DHT. Low T and high-grade prostate cancer, that is the problem.

    Victor Kantariya, MD

  6. Dear Dr. Kantariya:

    You are absolutely correct that use of 5-ARIs may increase risk for diagnosis with high-grade prostate cancer. The problem, however, is the absolute and relative degree of that risk, which is certainly small. As I am sure you appreciate, this has been debated for years, since the initial publication of the PCPT data.

    What we do not have, at this time, is any really useful data on the degree of such risk in the men who have the highest likelihood of benefiting from the ability of 5-ARIs to reduce risk for diagnosis with prostate cancer of any grade.

    Alas, we still have a complete lack of real understanding about what initiates the biological process of prostate cancer development and the degree to which this may (or may not) be dependent on levels of T and DHT in specific tissues at specific point in time during the male developmental and life cycles. Without such knowledge, there is a great deal of speculation tied to the possibility of associations between serum levels of specific hormones and risk for both indolent and clinically significant forms of prostate cancer.

  7. Dr. Sitemaster:

    I agree with your opinion; we need further investigation to elucidate the role of androgen therapy for men with prostate cancer. In addition to androgen deprivation therapy (ADT), bipolar androgen therapy (BAT) shows promise as treatment for castration-resistant prostate cancer. The regimen of BAT was well tolerated and has therapeutic potential. However, ADT was less safe. raised risk for cardiac death in men with prostate cancer, linked to higher stroke risk in older men. We should always take into consideration the possibility of modifying T or DHT to change cancer risk over time. Timing is everything, but it is difficult if not impossible to find a possible time limit.

  8. Dear Dr. Kantariya:

    I appreciate your suggestion that I might be a “Doctor” of some type … but I should be very clear that I am not. … Not even a PhD! I do, on the other hand, have some 40+ years of experience in the fields of scientific and medical communication, with specific interests in cancers and certain other types of rare disorder.

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