Low serum testosterone and prostate cancer behaviour - any correlation
Author(s): Preetam Penumatcha and Krishna Rao
Abstract:Background and Objective: Prostate cancer is one amongst the most common medical diseases affecting elderly men. Carcinoma of the prostate is being the most common non-cutaneous cancer diagnosed. The lifetime risk of prostatic carcinoma is 16.7 % and the risk of death during the entire lifetime is around 2.6% for men but the overall lifetime risk of death due to prostate malignancy is low in comparison to lifetime risk of diagnosis. Prostate cancer is a hormone dependant cancer and the clinical course of prostate cancer varies with individual and again it varies within the individual in relationship to serum testosterone levels. The present study is to find out the role of low serum testosterone level in predicting prostate cancer behaviour in comparison with normal serum testosterone level patients and to find out the relationship between low serum testosterone level and serum PSA levels in TRUS biopsy proven cancer prostate patients. The primary aim and objective of our study is to determine the association of low serum testosterone and prostate cancer behaviour and with a Secondary objective to determine the relationship of serum PSA level in cancer prostate patients with low serum testosterone. Methodology: Informed consent was obtained from all patients. All TRUS biopsy proven caner prostate patients were enrolled to a maximum number of 100. All details were recorded. Blood investigations like serum PSA, serum testosterone and other baseline investigations were obtained. The serum determinations of Testosterone obtained between 7 – 9.30 am. The serum Testosterone levels measured by appropriate standard protocols. Patients were divided into two groups based on the serum testosterone levels. Patients with low serum testosterone levels (< 250 ng/dl) were categorized as Group A and patients with normal serum testosterone levels (> 250 ng/dl) were categorized as Group B and the findings between two groups will be compared. Results: Total of 106 patients with cancer prostate were taken into our study of which 5 patients on 5 alpha reductase inhibitors and 1 patient on testosterone replacement therapy were excluded from our study and finally 100 patients were enrolled in our study of which patients with low testosterone level (<250 ng/dl) were categorized as group A and the remaining patients with normal testosterone level (> 250 ng/dl) were categorized as group B. The majority (74%) of patients in low testosterone group has got a serum PSA of more than 20 values compared with only 34% of patients in the corresponding group. P value is found to be statistically significant. Most of the patients (82.6%) in low testosterone group had a higher Gleason grade (8-10) compared to the normal testosterone group. P value is found statistically significant. Conclusion: Low total serum testosterone is associated with higher proportion of predominant Gleason pattern 4, an indicator of aggressive prostate cancer. Patients with low serum testosterone levels were associated with an increased serum PSA levels compared with patients in normal serum testosterone levels. Patients with low testosterone who were managed by radical prostatectomy had a higher proportion of positive surgical margin, extra capsular extension and seminal Vesical invasion suggesting an aggressive prostate cancer behaviour. Preoperative total testosterone should be routinely added to serum prostate specific antigen estimation to improve prostate cancer management.