On-line version ISSN 2078-5151
S. Afr. j. surg. vol.50 n.2 Cape Town May. 2012
M. M. AlsharefI; A. KahieII; M. ConradieIII; E. A. GoadIV; T. FourieV
IM.B. Ch.B., F.C.Urol. (S.A.), M.R.C.S. Eng., M.R.C.S. Ed., M.Med.Urol.; Department of Urology, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg
IIM.B. Ch.B., M.Med.Surg.; Department of Urology, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg
IIIM.B. Ch.B., F.C.Urol.; Department of Urology, Grey's Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg
IVM.B. Ch.B., F.C.Urol., M.Med.Sc., F.E.B.U., F.I.C.S., F.R.C.S. (Ireland).; Department of Urology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban
VM.B. Ch.B., M.Med.Urol.; Department of Urology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban
BACKGROUND: The association of serum free testosterone (FT) with prostate cancer is not fully understood. Studies on the results of the relationship between serum testosterone level and prostate cancer are conflicting. However, there is a reported association between lower serum testosterone levels and high-grade prostate cancer.
OBJECTIVE: To investigate the relationship between serum FT and the clinico-pathological characteristics of prostate cancer in South African patients.
MATERIALS AND METHODS: The clinical data of 109 consecutive patients diagnosed with prostate cancer on biopsy were evaluated prospectively. The variables were age, ethnic group, prostate-specific antigen (PSA), digital rectal examination (DRE) findings, clinical tumour, nodes and metastases (TNM) stage, and Gleason score. Low serum FT was defined as <250 ng/dl. Statistical analysis was performed using Stata V10 software (p<0.05 considered significant).
RESULTS: There was a statistically significant association between low serum FT and high serum PSA, high Gleason score and clinically advanced stage prostate cancer.
CONCLUSIONS: In this cohort of men with histologically diagnosed prostate cancer, low serum FT was associated with higher PSA, higher grade, and locally advanced or metastatic prostate cancer.
“Full text available only in PDF format”
1. Epstein J. The Lower Urinary Tract and Male Genital system. In: Kumar V, Abbas AK, Fausto N, Aster J, eds. Robbins and Cotran Pathologic Basis of Disease, 7th ed. Philadelphia: WB Saunders 2004:1047-1056. [ Links ]
2. Carter HB, Pearson JD, Metter EJ, et al. Longitudinal evaluation of serum androgen levels in men with and without prostate cancer. Prostate 1995;25-27. [ Links ]
3. Hsing AW, Comstock GW. Serological precursors of cancer: serum hormones and risk of subsequent prostate cancer. Cancer Epidemiol Biomarkers Prev 1993;2:27-32. [ Links ]
4. Gann PH, Hennekens CH, Ma J, et al. Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 1996;88: 1118-1126. [ Links ]
5. Slater S, Oliver RT. Testosterone: its role in development of prostate cancer and potential risk from use as hormone replacement therapy. Drugs Aging 2000;17:431-439. [ Links ]
6. Ribeiro M, Ruff P, Falkson G. Low serum testosterone and a younger age predict for a poor outcome in metastatic prostate cancer. Am J Clin Oncol 1997;20:605-608. [ Links ]
7. Schatzl G, Madersbacher S, Thurridl T, et al. High-grade prostate cancer is associated with low serum testosterone levels. Prostate 2001;47:52-58. [ Links ]
8. Zhang PL, Rosen S, Veeramachaneni R, et al. Association between prostate cancer and serum testosterone levels. Prostate 2002;53:179-182. [ Links ]
9. Hoffman MA, De Wolf WC, Morgentaler A. Is low serum free testosterone a marker for high-grade prostate cancer? J Urol 2000;163:824-827. [ Links ]
10. Hammes A, Andreassen TK, Spoelgen R, et al. Role of endocytosis in cellular uptake of sex steroids. Cell 2005;122:751-762. [ Links ]
11. Manni A, Pardridge WM, Cefalu W, et al. Bioavailability of albuminbound testosterone. J Clin Endocrinol Metab 1985;61:705-710. [ Links ]
12. Nieschlag E, Swerdloff R, Behre HM, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males. ISA, ISSAM, and EAU recommendations. Eur Urol 2005;48(1):1-4. [ Links ]
13. Wilke TJ, Utley DJ. Total testosterone, free-androgen index, calculated free testosterone, and free testosterone by analog RIA compared in hirsute women and in otherwise-normal women with altered binding of sex-hormone-binding globulin. Clin Chem 1987; 33:1372-1375. [ Links ]
14. Andersson S.O., Adami H.O., Bergström R., et al. Serum pituitary and sex steroid hormone levels in the etiology of prostatic cancer - a population-based case-control study. Br J Cancer 1993; 68: 97-102. [ Links ]
15. Morgentaler A, Bruning CO, De Wolf WC. Occult prostate cancer in men with low serum testosterone levels. JAMA 1996;276:1904-1906. [ Links ]
16. Mohr BA, Feldman HA, Kalish LA, et al. Are serum hormones associated with the risk of prostate cancer? Prospective results from the Massachusetts Male Aging Study. Urology 2001;57:930-935. [ Links ]
17. Pérez Márquez M, García-Cruz E, Piqueras Bartolomé M, et al. Low testosterone levels are associated with poor prognosis risk factors on needle prostate cancer biopsies. J Men's Health 2009;3:252. [ Links ]
18. Carter HB, Pearson JD, Metter EJ, et al. Longitudinal evaluation of serum androgen levels in men with and without prostate cancer. Prostate 1995;27(1):25-27. [ Links ]
19. Massengill JC, Sun L, Moul JW, et al. Pretreatment total testosterone level predicts pathological stage in patients with localised prostate cancer treated with radical prostatectomy. J Urol 2003;169:1670-1675. [ Links ]
20. Schatzl G, Madersbacher S, Haitel A, et al. Associations of serum testosterone with microvessel density, androgen receptor density and androgen receptor gene polymorphism in prostate cancer. J Urol 2003;169:1312-1315. [ Links ]
21. Tenover JS, Matsumoto AM, Plymate SR, et al. The effects of aging in normal men on bioavailable testosterone and luteinizing hormone secretion: response to clomiphene citrate. J Clin Endocrinol Metab 1987;65:1118-1226. [ Links ]
22. Mitchell R, Hollis S, Rothwell C, et al. Age-related changes in the pituitary-testicular axis in normal men: lower serum testosterone results from decreased bioactive LH drive. Clin Endocrinol 1995;42:501-507. [ Links ]
23. Evans HS, Moller H. Recent trends in prostate cancer incidence and mortality in southeast England. Eur Urol 2003;43:337-341. [ Links ]
24. Sandblom G, Varenhorst E, Lofman O, et al. Clinical consequences of screening for prostate cancer: 15 years follow-up of a randomised controlled trial in Sweden. Eur Urol 2004;46:717-723. [ Links ]
25. Paquette EL, Sun L, Paquette LR, et al. Improved prostate cancer-specific survival and other disease parameters: impact of prostate-specific antigen testing. Urology 2002;60:756-759. [ Links ]
26. Heyns CF, Fisher M, Lecuona A, van der Merwe A. Prostate cancer among different racial groups in the Western Cape: Presenting features and management. S Afr Med J 2011;101:267-270. [ Links ]
27. Martins ACP, Reis RB, Suaid HJ, et al. Screening for carcinoma of the prostate in volunteers. Braz J Urol 2000;26:516-522. [ Links ]