UROLOGICAL ONCOLOGY

Low serum testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy: hypogonadism represents bad prognosis in prostate cancer
Teloken C, Da Ros CT, Caraver F, Weber FA, Cavalheiro AP, Graziottin TM
Urology Department, Santa Casa Hospital, Porto Alegre, RS, Brazil
J Urol. 2005; 174: 2178-80

• Purpose: It has been reported that more aggressive prostate cancer (PC) can be associated with low serum testosterone levels. The relationship between serum androgens and PC is still not completely understood. In this study we examined the association of prognostic factors in men who underwent radical retropubic (RRP) prostatectomy with low or normal total testosterone.
• Materials and Methods: We retrospectively evaluated 64 consecutive patients with localized PC treated with RRP between July 2002 and November 2003. PC was diagnosed by transrectal ultrasonography guided biopsy performed for either a suspicious digital rectal examination or serum prostate specific antigen greater than 4.0 ng/mL. Gleason score was determined in prostatic biopsies. Pathological TNM staging (1997), capsular perforation, seminal vesicle involvement and surgical margin status were determined in all surgical specimens. The threshold for serum total testosterone was 270 ng/dL. In all analyses p < 0.05 was considered statistically significant.
• Results: There were no statistically significant differences among prostate specific antigen, Gleason score (biopsy or specimen), pathological stage, capsular perforation and seminal vesicle involvement. However, patients with low total testosterone had increased positive surgical margins (p = 0.026).
• Conclusions: Patients with low total testosterone more frequently present with positive surgical margins in RRP specimens. The true association between low testosterone and poor clinical outcome in the long term needs validation in large prospective studies.
  
  
• Editorial Comment
  Prostate cancer is hormone dependent. Suppression of androgen levels inhibits cancer growth, at least for a while. Does this statement justify the inverse assumption that high androgen levels support growth of prostate cancer in males? The authors from Brazil address this important topic in correlating the histological parameters of prostatectomy specimen with androgen levels in the respective patients. No correlation was found except that patients with low testosterone had more positive margins. Interestingly, testosterone levels were significantly increased after the operation.
  Thus, upon first view, testosterone seems to be inversely correlated to cancer growth in males. Other researches on the cellular testosterone receptor also support this notion.
  Certainly, more data from much larger patient cohorts are needed to clarify this important issue.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany