World Journal of Urology

, Volume 31, Issue 2, pp 253–259 | Cite as

Circulating free testosterone is an independent predictor of advanced disease in patients with clinically localized prostate cancer

  • Thomas Schnoeller
  • Florian Jentzmik
  • Ludwig Rinnab
  • Marcus V. Cronauer
  • Ilija Damjanoski
  • Friedemann Zengerling
  • Andreas Al Ghazal
  • Mark Schrader
  • Andres J. Schrader
Original Article

Abstract

Purpose

To evaluate the clinical value of the pre-treatment calculated free testosterone (fT), total testosterone (tT), sexual hormone-binding globulin (SHBG) and estradiol (E2) levels as potential predictors of pathological stage and grade in patients with clinically localized prostate cancer.

Methods

Preoperative sex hormone serum levels were prospectively measured in 137 patients who underwent radical prostatectomy at the University Hospital Ulm from February 2011 to February 2012. We related sex hormone levels to clinicopathologic data including tumour stage, Gleason score and prostate specific antigen (PSA). (Non)parametric statistical tests and receiver operating characteristics (ROC) analyses were performed.

Results

Preoperative serum fT levels were significantly associated with advanced disease (pT3–4 and/or pN+; p = 0.047) and lymph node involvement (pN+) (p = 0.027). Patients with low (<0.047 μg/l) vs. normal fT values (≥0.047 μg/l) were associated with higher tumour stage (p = 0.049), positive lymph node status (pN+ , p = 0.038) and advance disease (p = 0.016). Moreover, low tT values (≤0.193 μg/l; p = 0.018) and elevated SHBG levels (>48.4 nmol/l, p = 0.043) correlated with a higher Gleason score. Conversely, E2 levels were not associated with tumour stage or grade. Applying multivariate analysis, unlike tT, SHBG, and E2 levels, low fT levels were a significant independent predictor of advanced disease (relative hazard ratio 3.05, p = 0.028).

Conclusions

Low pre-treatment fT levels were significantly associated with tumour stage and extraprostatic tumour spread and might—in addition or combination with PSA—serve as a useful prognostic parameter for prostate cancer patients prior to radical prostatectomy.

Keywords

Testosterone Prostatectomy Prostate cancer 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    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
  2. 2.
    Sher DJ, Mantzoros C, Jacobus S, Regan MM, Lee GS, Oh WK (2009) Absence of relationship between steroid hormone levels and prostate cancer tumor grade. Urology 73:356–361PubMedCrossRefGoogle Scholar
  3. 3.
    Solania 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 117:3953–3962CrossRefGoogle Scholar
  4. 4.
    Ribeiro M, Ruff P, Falkson G (1997) Low serum testosterone and a younger age predict for poor outcome in metastatic prostate cancer. Am J Clin Oncol 20:605–608PubMedCrossRefGoogle Scholar
  5. 5.
    Schatzl G, Madersbacher S, Thurridl T, Waldmüller J, Kramer G, Haitel A, Marberger M (2001) High-grade prostate cancer is associated with low serum testosterone levels. Prostate 47:52–58PubMedCrossRefGoogle Scholar
  6. 6.
    Massengill JC, Sun L, Moul JW, Wu H, McLeod DG, Amling C, Lance R, Foley J, Sexton W, Kusuda L, Chung A, Soderdahl D, Donahue T (2003) Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 169:1670–1675PubMedCrossRefGoogle Scholar
  7. 7.
    Lee SE, Chung JS, Han BK, Park CS, Moon KH, Byun SS, Choe G, Hong SK (2008) Preoperative serum sex hormone-binding globulin as a predictive marker for extraprostatic extension of tumor in patients with clinically localized prostate cancer. Eur Urol 54:1324–1332PubMedCrossRefGoogle Scholar
  8. 8.
    Salonia A, Gallina A, Briganti A, Zanni G, Suardi N, Capitanio U, Colombo R, Bertini R, Freschi M, Guazzoni G, Rigatti P, Montorsi F (2011) Sex hormone-binding globulin is a significant predictor of extracapsular extension in men undergoing radical prostatectomy. BJU Int 107:1243–1249PubMedCrossRefGoogle Scholar
  9. 9.
    Solania A, Briganti A, Gallina A et al (2009) Sex hormone-binding globulin: a novel marker for nodal metastases prediction in prostate cancer patients undergoing extended pelvic lymph node dissection. Urology 73:850–855CrossRefGoogle Scholar
  10. 10.
    Hoffman MA, DeWolf WC, Morgentaler A (2000) Is low serum free testosterone a marker for high grade prostate cancer? J Urol 163:824–827PubMedCrossRefGoogle Scholar
  11. 11.
    Morote J, Ramirez C, Gomez E, Planas J, Raventos CX, de Torres IM, Catalan R (2009) The relationship between total and free serum testosterone and the risk of prostate cancer and tumour aggressiveness. BJU Int 104:486–489PubMedCrossRefGoogle Scholar
  12. 12.
    Bonkhoff H, Berges R (2009) The evolving role of oestrogens and their receptors in the development and progression of prostate cancer. Eur Urol 55:533–542PubMedCrossRefGoogle Scholar
  13. 13.
    Carruba G (2007) Estrogen and prostate cancer: an elipsed truth in an androgen-dominated scenario. J Cell Biochem 102:899–911PubMedCrossRefGoogle Scholar
  14. 14.
    Solania A, Gallina A, Briganti A, Suardi N, Capitano 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 117:5029–5038CrossRefGoogle Scholar
  15. 15.
    Vermeulen A, Verdonck L, Kaufmann JM (1999) A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 84:3666–3672PubMedCrossRefGoogle Scholar
  16. 16.
    Isom-Batz G, Bianco FJ Jr, 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
  17. 17.
    Imamoto T, Suzuki H, Fukasawa S, Shimbo M, Inahara M, Komiya A, Ueda T, Shiraishi T, Ichikawa T (2005) Pretreatment serum testosterone level as a predictive factor of pathological stage in localized prostate cancer patients treated with radical prostatectomy. Eur Urol 47:308–312PubMedCrossRefGoogle Scholar
  18. 18.
    Teloken C, Da Ros CT, Weber FA, Cavalheiro AP, Graziottin TM (2005) Low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy: hypogonadism represents bad prognosis in prostate cancer. J Urol 174:2178–2180PubMedCrossRefGoogle Scholar
  19. 19.
    Nishiyama T, Ikarashi T, Hashimoto Y, Suzuki K, Takahashi K (2006) Association between the dihydrotestosterone level in the prostate and prostate cancer aggressiveness using the Gleason score. J Urol 176:1387–1391PubMedCrossRefGoogle Scholar
  20. 20.
    Zhang PL, Rosen S, Veeramachaneni R, Kao J, DeWolf WC, Bubley G (2002) Association between prostate cancer and serum testosterone levels. Prostate 53:179–182PubMedCrossRefGoogle Scholar
  21. 21.
    Miller LR, Partin AW, Chan DW, Bruzek DJ, Dobs AS, Epstein JI, Walsh PC (1998) Influence of radical prostatectomy on serum hormone levels. J Urol 160:449PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Thomas Schnoeller
    • 1
  • Florian Jentzmik
    • 1
  • Ludwig Rinnab
    • 1
  • Marcus V. Cronauer
    • 1
  • Ilija Damjanoski
    • 1
  • Friedemann Zengerling
    • 1
  • Andreas Al Ghazal
    • 1
  • Mark Schrader
    • 1
  • Andres J. Schrader
    • 1
  1. 1.Department of UrologyUniversity Hospital UlmUlmGermany

Personalised recommendations