Serum testosterone is associated with aggressive prostate cancer in older men

Results from the Baltimore Longitudinal Study of Aging

Phillip M. Pierorazio, Luigi Ferrucci, Anna Kettermann, Dan L. Longo, E. Metter, H. Ballentine Carter

Research output: Contribution to journalArticle

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Abstract

Study Type - Prognosis (inception cohort) Level of Evidence 1b Objective: To evaluate the relationship between testosterone levels and the development of high-risk prostate cancer, by prospectively examining serum androgen concentrations in a well-studied cohort, as the role of testosterone in prostate cancer progression is debated. Patients and methods: The study comprised 781 men in the Baltimore Longitudinal Study of Aging who had sex steroid measurements before a diagnosis of prostate cancer, or at their last visit for those without cancer (no cancer, 636; cancer, not high risk, 109; cancer, high risk, 36). High-risk cancer was defined as death from prostate cancer, a prostate specific antigen (PSA) level of ≥20 ng/mL at diagnosis, or a Gleason score of ≥8. The hazard ratio (HR) of high-risk disease was determined using a Cox proportional hazards regression model with simple updating, and risk rates were stratified by age and tercile for androgens of interest based on the proportional hazards analyses. Results: The likelihood of high-risk prostate cancer doubled per unit (0.1) increase in the free testosterone index (FTI) for patients aged >65 years (HR 2.07, 95% confidence interval, CI, 1.01-4.23; P = 0.047); the likelihood for men aged ≤65 years was inversely related to the FTI (HR 0.96, 95% CI 0.35-2.6; P = 0.9). The risk rate per person-years increased from lowest to highest tercile of FTI for the oldest men (age >70 years) but this trend was not apparent among younger men. Conclusion: Higher levels of serum free testosterone are associated with an increased risk of aggressive prostate cancer among older men. These data highlight the importance of prospective trials to insure the safety of testosterone-replacement therapy.

Original languageEnglish (US)
Pages (from-to)824-829
Number of pages6
JournalBJU International
Volume105
Issue number6
DOIs
StatePublished - Mar 1 2010

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Baltimore
Longitudinal Studies
Testosterone
Prostatic Neoplasms
Serum
Neoplasms
Androgens
Neoplasm Grading
Prostate-Specific Antigen
Proportional Hazards Models
Odds Ratio
Steroids
Confidence Intervals
Safety

All Science Journal Classification (ASJC) codes

  • Urology

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Serum testosterone is associated with aggressive prostate cancer in older men : Results from the Baltimore Longitudinal Study of Aging. / Pierorazio, Phillip M.; Ferrucci, Luigi; Kettermann, Anna; Longo, Dan L.; Metter, E.; Carter, H. Ballentine.

In: BJU International, Vol. 105, No. 6, 01.03.2010, p. 824-829.

Research output: Contribution to journalArticle

Pierorazio, Phillip M. ; Ferrucci, Luigi ; Kettermann, Anna ; Longo, Dan L. ; Metter, E. ; Carter, H. Ballentine. / Serum testosterone is associated with aggressive prostate cancer in older men : Results from the Baltimore Longitudinal Study of Aging. In: BJU International. 2010 ; Vol. 105, No. 6. pp. 824-829.
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abstract = "Study Type - Prognosis (inception cohort) Level of Evidence 1b Objective: To evaluate the relationship between testosterone levels and the development of high-risk prostate cancer, by prospectively examining serum androgen concentrations in a well-studied cohort, as the role of testosterone in prostate cancer progression is debated. Patients and methods: The study comprised 781 men in the Baltimore Longitudinal Study of Aging who had sex steroid measurements before a diagnosis of prostate cancer, or at their last visit for those without cancer (no cancer, 636; cancer, not high risk, 109; cancer, high risk, 36). High-risk cancer was defined as death from prostate cancer, a prostate specific antigen (PSA) level of ≥20 ng/mL at diagnosis, or a Gleason score of ≥8. The hazard ratio (HR) of high-risk disease was determined using a Cox proportional hazards regression model with simple updating, and risk rates were stratified by age and tercile for androgens of interest based on the proportional hazards analyses. Results: The likelihood of high-risk prostate cancer doubled per unit (0.1) increase in the free testosterone index (FTI) for patients aged >65 years (HR 2.07, 95{\%} confidence interval, CI, 1.01-4.23; P = 0.047); the likelihood for men aged ≤65 years was inversely related to the FTI (HR 0.96, 95{\%} CI 0.35-2.6; P = 0.9). The risk rate per person-years increased from lowest to highest tercile of FTI for the oldest men (age >70 years) but this trend was not apparent among younger men. Conclusion: Higher levels of serum free testosterone are associated with an increased risk of aggressive prostate cancer among older men. These data highlight the importance of prospective trials to insure the safety of testosterone-replacement therapy.",
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