Impact and Outcomes of Pretreatment Total Serum Testosterone on Localized Prostate Cancer Patients.

Brittni M Usera,Jonathan D Tward,Polly Creveling

doi:10.1155/2020/8357452

Abstract

Purpose To investigate how pretreatment testosterone levels correlate with progression-free survival, metastasis-free survival, and overall survival in a propensity-adjusted localized prostate cancer population. Methods Men diagnosed with clinical NCCN-risk stratified very-low, low, intermediate, high, and/or very-high risk prostate cancer who had a baseline total serum testosterone level≥100 ng/dl measured within the 100 days preceding the first definitive therapy were identified from our prospectively gathered institutional database. Cohorts below (100–239 ng/dl), within (240–593 ng/dl), or above (594 + ng/dl) one standard deviation from the mean testosterone level (416 ng/dl) were used for comparison. Progression-free, metastasis-free, and overall survival were evaluated. A separate cohort of men not receiving ADT was used to evaluate testosterone recovery after various treatment modalities (surgery, external beam radiation, brachytherapy, or combined EBRT + Brachy). Results There was no statistically significant difference between the low, average, and high testosterone cohorts for PFS, MFS, or OS. In men not using ADT, there were no statistically significant changes in testosterone levels 1 year after therapy, regardless of therapy type. Conclusion In men with serum testosterone levels >=100 ng/dl at diagnosis, baseline testosterone does not impact PFS, MFS, or OS. Recovery of testosterone back to baseline is expected for men undergoing either surgery, external beam or brachytherapy, or combined modality radiation when not using ADT.

Highlights

In the 1940s, Huggins and Hodges discovered that ADT led to the regression of metastatic prostate cancer [1]. is observation, and others from in vitro work, led to the androgen hypothesis of prostate cancer pathogenesis, which theorizes that high androgen concentration increases prostate cancer risk and low testosterone was protective [2]
None of the published studies to date have evaluated the correlation between pretreatment serum testosterone and metastasisfree survival, or how combined modality radiations like EBRT and brachytherapy correlate with outcomes stratified by pretreatment testosterone levels
We attempted to minimize some of the limitations of these other studies by using data from a prospectively gathered institutional database of all prostate cancer patients, and by using a rigorous statistical approach that attempted to control for the confounding of other known prognostic indicators and various treatment modalities

Summary

Introduction

In the 1940s, Huggins and Hodges discovered that ADT led to the regression of metastatic prostate cancer [1]. is observation, and others from in vitro work, led to the androgen hypothesis of prostate cancer pathogenesis, which theorizes that high androgen concentration increases prostate cancer risk and low testosterone was protective [2]. Over the past few decades, numerous researchers have investigated the correlation of pretreatment serum testosterone levels with cancer aggressiveness at diagnosis and clinical outcomes. E majority of studies evaluating the relationship between pretreatment testosterone and staging or oncologic outcomes have been performed in men who received a radical prostatectomy. Fewer studies have been performed in men who have received radiation therapy [4,5,6,7,8,9,10,11]. E aim of this study was to investigate how pretreatment testosterone levels correlate with biochemical failurefree survival, metastasis-free survival, and overall survival in a propensity-adjusted population that accounts for the NCCN-risk group [12] (version 2.2019), type of radiation or surgical therapy delivered, and use of neoadjuvant, Prostate Cancer concurrent, or adjuvant ADT.

Methods

Results

Conclusion