MedicalResearch: What are the main findings of the study?
Answer: Increasingly, men with low-risk prostate cancer are undergoing a close monitoring regimen called active surveillance, instead of moving forward immediately with treatment. However it is still unclear which men will develop evidence for worsening or more aggressive disease during active surveillance. In this study of 154 men with Gleason 6 prostate cancer followed for 38 months, we found that low levels of free testosterone were significantly associated with increased risk of developing more aggressive disease. We found no significant association with total testosterone concentrations, although there was a general trend towards increased risk with lower levels.
MedicalResearch: Were any of the findings unexpected?
Answer: Not totally, because we already published few years ago that men with low free testosterone had more aggressive prostate cancer.
MedicalResearch: What should clinicians and patients take away from your report?
Answer: These results suggest low levels of testosterone are associated with more aggressive prostate cancer. This contradicts long-held beliefs that high testosterone is risky for prostate cancer, and low testosterone is protective.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Answer: The results of this study provide additional valuable information to clinicians and their patients regarding risk factors for prostate cancer progression in men undergoing active surveillance. In borderline cases, the presence of low values of free testosterone may help determine whether it is more prudent to initiate treatment rather than continue observation.
San Francisco, I. F., Rojas, P. A., DeWolf, W. C. and Morgentaler, A. (2014), Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance. BJU International. doi: 10.1111/bju.12682