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Summary
This summary is machine-generated.

Low testosterone levels in men with prostate cancer (PC) are linked to higher mortality risks, particularly in those with minimal comorbidity. Early diagnosis and risk stratification are crucial for improving outcomes in PC patients.

Keywords:
mortalityprostate cancerprostate‐specific antigentestosteronetransgender

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Area of Science:

  • Urology
  • Oncology
  • Endocrinology

Background:

  • Low serum testosterone can delay prostate cancer (PC) diagnosis by prolonging the time for prostate-specific antigen (PSA) to exceed normal levels.
  • This study investigates PC aggressiveness and mortality risks in relation to testosterone levels within comorbidity subgroups.

Purpose of the Study:

  • To evaluate the impact of low versus normal serum testosterone on PC aggressiveness and mortality.
  • To assess PC-specific and all-cause mortality (PCSM, ACM) risk within comorbidity subgroups.

Main Methods:

  • A randomized trial cohort of 350 unfavorable-risk PC patients (T1c-4N0M0) between 2005-2015.
  • Fine and Gray and Cox regression analyses were used to assess PCSM and ACM risk, adjusting for prognostic factors and treatment.
  • An interaction term evaluated testosterone's effect across different comorbidity levels (Adult Comorbidity Evaluation-27).

Main Results:

  • After a median follow-up of 10.2 years, 89 patients died (25.43%), with 47.19% of deaths due to PC.
  • In patients with no or minimal comorbidity, low testosterone was significantly associated with increased PCSM (AHR: 2.70) and ACM (AHR: 1.90) compared to normal testosterone.
  • No significant association was observed in patients with moderate to severe comorbidity.

Conclusions:

  • Low serum testosterone is an independent risk factor for increased PC-specific and all-cause mortality in men with minimal comorbidity.
  • Multiparametric MRI (mpMRI) is unaffected by testosterone levels and may aid in PC screening and risk stratification.
  • Further research should consider incorporating mpMRI into PC screening protocols for individuals with low testosterone to potentially reduce PCSM.