Low testosterone level is an independent risk factor for high-grade prostate cancer detection at biopsy.
Level 3 - non-randomized controlled study
Retrospective cohort study analyzing clinical and pathological risk factors in biopsy patients
PubMed 26086732 · doi:10.1111/bju.13206
What was done
A retrospective cohort study of 681 men who underwent an initial 12-core transrectal prostate biopsy at a single institution. Patients were grouped by pre-biopsy serum testosterone into low (<300 ng/dL) and normal (≥300 ng/dL) categories. Univariate and multivariate logistic regression models were used to evaluate whether low testosterone predicted overall prostate cancer detection and high-grade prostate cancer detection, adjusting for age, prostate-specific antigen (PSA), prostate volume, body mass index (BMI), abnormal digital rectal examination (DRE) findings, and diabetes mellitus history.
What was found
Among 681 men, 86 (12.6%) had low testosterone, 143 (32.7%) had a positive biopsy, and 99 (14.5%) had high-grade prostate cancer. Low testosterone was associated with overall prostate cancer on univariate analysis (OR 2.545, P = 0.001), but lost significance in multivariate analysis (OR 1.583, P = 0.277). For high-grade prostate cancer, low testosterone remained significantly associated in both univariate analysis (OR 3.324, P < 0.001) and multivariate analysis (OR 2.138, P = 0.035).
Why it matters
The findings suggest baseline serum testosterone might serve as an adjunct clinical biomarker to help risk-stratify biopsy candidates for aggressive, high-grade disease.
Limits
The study is retrospective and conducted at a single institution. Only 86 patients had low testosterone. The abstract does not report the specific Gleason score threshold used to define high-grade disease, whether repeat morning testosterone testing was done to verify hypogonadism, or long-term clinical and oncological outcomes.
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