Low Testosterone Levels and Grade Group Progression Among Localized Prostate Cancer Patients on Active Surveillance:...

Area of Science:

• Urology
• Oncology
• Endocrinology

Background:

• Active surveillance (AS) is a common strategy for localized prostate cancer.
• Biomarkers for predicting disease progression during AS are limited.
• The role of low testosterone in prostate cancer progression during AS is unclear.

Purpose of the Study:

• To investigate the association between baseline serum testosterone levels and grade group progression in men with localized prostate cancer undergoing AS.
• To determine if low testosterone predicts progression to higher grade groups (GG3+).

Main Methods:

• Retrospective cohort study of 924 men in an AS program (2001-2024).
• Serum testosterone levels categorized as low (≤ 300 ng/dL).
• Cox proportional hazards models used to assess associations with GG2 and GG3+ progression, adjusting for confounders.

Main Results:

• Low testosterone was associated with a significantly increased risk of GG3+ progression (HR 1.61, p=0.04).
• Low testosterone was not significantly associated with GG2 progression (HR 1.23, p=0.15).
• Findings were robust to alternative testosterone cut-points and confounder adjustments.

Conclusions:

• Low testosterone may be a risk factor for higher-grade prostate cancer progression (GG3+) during AS.
• Low testosterone does not appear to be associated with moderate progression (GG2).
• Prospective studies are needed to validate these findings and explore the androgen-prostate cancer relationship.