World Journal of Urology

, Volume 31, Issue 2, pp 247–252 | Cite as

Low serum testosterone levels are predictive of prostate cancer

  • Luigi Mearini
  • Alessandro Zucchi
  • Elisabetta Nunzi
  • Tommaso Villirillo
  • Vittorio Bini
  • Massimo Porena
Original Article



Although hormones play fundamental roles in prostate growth, their clinical significance is not completely clear. Aims of present study were to assess whether testosterone and serum sex hormone levels are predictors of benign prostatic hyperplasia (BPH) or prostate cancer (PC) and to verify whether prostate cancer is associated with low testosterone levels, and to test association between testosterone levels and known prognostic factors in prostate cancer.


In 206 consecutive patients with benign prostatic hyperplasia or prostate cancer testosterone, follicle-stimulating hormone, luteinizing hormone and prolactin levels were tested and correlated with disease. In patients with prostate cancer, hormone levels were also correlated with known prognostic factors. Predictive value was assessed for age, prostate-specific antigen (PSA), PSA ratio, PSA density, prostate volume and serum sex hormone levels using multiple logistic regression analysis and receiver operating characteristic curves.


Considering sex hormones, only testosterone levels were significantly lower in patients with prostate cancer than those with BPH; testosterone levels appear to be independent predictor of prostate cancer, enhancing predictive accuracy for BPH and PC. Testosterone levels do not seem to be associated with known clinical prognostic factors.


This study supports experimental findings that testosterone levels are predictor of prostate cancer and that prostate cancer is frequently associated with low testosterone levels. In the diagnostic work-up for prostate cancer, adding testosterone determination to PSA test may improve predictive accuracy.


Testosterone Prostate-specific antigen (PSA) Benign prostatic hyperplasia (BPH) Prostate cancer 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Vergho DC, Heine K, Wolff JM (2005) The role of PSA in diagnosis of prostate cancer and its recurrence. Pathologe 26:473–478PubMedCrossRefGoogle Scholar
  2. 2.
    Roobol MJ, Schröder FH, van Leeuwen P, Wolters T, van den Bergh RC, van Leenders GJ, Hessels D (2010) Performance of the prostate cancer antigen 3 (PCA3) gene and prostate-specific antigen in prescreened men: exploring the value of PCA3 for a first-line diagnostic test. Eur Urol 58:475–481PubMedCrossRefGoogle Scholar
  3. 3.
    Tricoli JV, Schoenfeldt M, Conley BA (2004) Detection of prostate cancer and predicting progression: current and future diagnostic markers. Clin Cancer Res 10:3943–3953PubMedCrossRefGoogle Scholar
  4. 4.
    Singh AS, Chau CH, Price DK, Figg WD (2005) Mechanisms of disease: polymorphisms of androgen regulatory genes in the development of prostate cancer. Nat Clin Pract Urol 2:101–107PubMedCrossRefGoogle Scholar
  5. 5.
    Rubio J, Ramos D, Lopez-Guerrero JA, Iborra I, Collado A, Solsona E, Almenar S, Llombart-Bosch A (2005) Immunohistochemical expression of Ki-67 antigen, cox-2 and Bax/Bcl-2 in prostate cancer; prognostic value in biopsies and radical prostatectomy specimens. Eur Urol 48:745–751PubMedCrossRefGoogle Scholar
  6. 6.
    English HF, Kloszewski ED, Valentine E, Santen RJ (1986) Proliferative response of the Dunning R3327H experimental model of prostatic adenocarcinoma to conditions of androgen depletion, repletion. Cancer Res 46:839PubMedGoogle Scholar
  7. 7.
    Porter A, Ben-Josef E, Crawford ED, Garde S, Huhtaniemi I, Pontes JE (2001) Advancing perspectives on prostate cancer: multihormonal influences in pathogenesis. Mol Urol 5:181–188PubMedCrossRefGoogle Scholar
  8. 8.
    Hilz H, Graefen M, Noldus J, Hammerer P, Knabbe C, Huland E, Huland H (2000) Advanced prostate cancer is associated with a decrease in serum luteinizing hormone. Eur Urol 38:243–249PubMedCrossRefGoogle Scholar
  9. 9.
    Rouet V, Bogorad RL, Kayser C, Kessal K, Genestie C, Bardier A, Grattan DR, Kelder B, Kopchick JJ, Kelly PA, Goffin V (2010) Local prolactin is a target to prevent expansion of basal/stem cells in prostate tumors. Proc Natl Acad Sci USA 107:15199–15204PubMedCrossRefGoogle Scholar
  10. 10.
    Roddam AW, Allen NE, Appleby P, Key TJ (2008) Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 100:170–183PubMedCrossRefGoogle Scholar
  11. 11.
    Morgentaler A (2007) Testosterone replacement therapy and prostate cancer. Urol Clin North Am 34:555–563PubMedCrossRefGoogle Scholar
  12. 12.
    Morgentaler A, Traish AM (2009) Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol 55:310–320PubMedCrossRefGoogle Scholar
  13. 13.
    Morgentaler A, Rhoden EL (2006) Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/ml or less. Urology 68:1263–1267PubMedCrossRefGoogle Scholar
  14. 14.
    Rannikko S, Adlercreutz H (1983) Plasma estradiol, free testosterone, sex hormone binding globulin binding capacity, and prolactin in benign prostatic hyperplasia and prostatic cancer. Prostate 4:223–229PubMedCrossRefGoogle Scholar
  15. 15.
    Kumar VL, Wadhwa SN, Kumar V, Farooq A (1990) Androgen, estrogen, and progesterone receptor contents and serum hormone profiles in patients with benign hypertrophy and carcinoma of the prostate. J Surg Oncol 44:122–128PubMedCrossRefGoogle Scholar
  16. 16.
    Schatzl G, Brossner C, Schimd S, Kugler W, Roehrich M, Treu T (2000) Endocrine status in elderly men with lower urinary tract symptoms: correlation of age, hormonal status, and lower urinary tract function. The Prostate Study Group of the Austrian Society of Urology. Urology 55:397–402PubMedCrossRefGoogle Scholar
  17. 17.
    Mearini L, Costantini E, Zucchi A, Mearini E, Bini V, Cottini E, Porena M (2008) Testosterone levels in benign prostatic hypertrophy and prostate cancer. Urol Int 80:134–140PubMedCrossRefGoogle Scholar
  18. 18.
    Miller LR, Partin AW, Chan DW, Bruzek DJ, Dobs AS, Epstein JI (1998) Influence of radical prostatectomy on serum hormone levels. J Urol 160:449PubMedCrossRefGoogle Scholar
  19. 19.
    Heracek J, Hampl R, Hill M, Starka L, Sachova J, Kuncova J, Eis V, Urban M, Mandys V (2007) Tissue and serum levels of principal androgens in benign prostatic hyperplasia and prostate cancer. Steroids 72:375–380PubMedCrossRefGoogle Scholar
  20. 20.
    Shaneyfelt T, Husein R, Bubley G, Mantzoros CS (2000) Hormonal predictors of prostate cancer: a meta-analysis. J Clin Oncol 18:847–853PubMedGoogle Scholar
  21. 21.
    Isom-Batz G, Bianco FJ, Kattan MW, Mulhall JP, Lilja H, Eastham JA (2005) Testosterone as a predictor of pathological stage in clinically localized prostate cancer. J Urol 173:1935–1937PubMedCrossRefGoogle Scholar
  22. 22.
    Zagars GK, Pollack A, von Eschenbach AC (1997) Serum testosterone—a significant determinant of metastatic relapse for irradiated localized prostate cancer. Urology 49:327PubMedCrossRefGoogle Scholar
  23. 23.
    Salonia A, Gallina A, Briganti A, Suardi N, Capitanio U, Abdollah F, Bertini R, Freschi M, Rigatti P, Montorsi F (2011) Circulating estradiol, but not testosterone, is a significant predictor of high-grade prostate cancer in patients undergoing radical prostatectomy. Cancer. doi: 10.1002/cncr.26136
  24. 24.
    Salonia A, Gallina A, Briganti A, Abdollah F, Suardi N, Capitanio U, Colombo R, Freschi M, Rigatti P, Montorsi F (2011) Preoperative hypogonadism is not an independent predictor of high-risk disease in patients undergoing radical prostatectomy. Cancer 1117:3953–3962CrossRefGoogle Scholar
  25. 25.
    Harper ME, Wilson DW, Jensen HM, Pierrepoint CG, Griffiths K (1987) Steroid hormone concentrations in relation to patient prognosis and prostate tumor grade. J Urol 27:521–524Google Scholar
  26. 26.
    Chen SS, Chen KK, Lin ATL, Chang H, Wu HH, Chang LS (2002) The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis. BJU Int 89:710–713PubMedCrossRefGoogle Scholar
  27. 27.
    Porter AT, F.A.C.R.O, Ben-Josef E (2001) Humoral mechanisms in prostate cancer: a role for FSH. Urol Oncol 6:131–138PubMedCrossRefGoogle Scholar
  28. 28.
    Tian W, Osawa M, Horiuchi H, Tomita Y (2004) Expression of the prolactin-inducible protein (PIP/GCDFP15) gene in benign epithelium and adenocarcinoma of the prostate. Cancer Sci 95:491–495PubMedCrossRefGoogle Scholar
  29. 29.
    Garcia-Cruz E, Huguet J, Piqueras M, Perez Marquez M, Peri L, Izquierdo L, Franco A, Alvarez-Vijande R, Ribal MJ, Alcaraz A (2011) Low testosterone bioavailability is related to prostate cancer diagnose in patients submitted to prostate biopsy. World J Urol. doi: 10.1007/s00345-011-0741-9

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Luigi Mearini
    • 1
  • Alessandro Zucchi
    • 1
  • Elisabetta Nunzi
    • 1
  • Tommaso Villirillo
    • 1
  • Vittorio Bini
    • 2
  • Massimo Porena
    • 1
  1. 1.Urology DepartmentUniversity of PerugiaPerugiaItaly
  2. 2.Internal Medicine DepartmentUniversity of PerugiaPerugiaItaly

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