Low T could hasten time to post-RP biochemical recurrence

Men with low levels of free testosterone 3 months after undergoing radical prostatectomy could face increased chance of early recurrence of prostate cancer, according to researchers from the University of California Irvine.

It’s a finding that could point to the benefit of testosterone replacement therapy in men with low free testosterone and total testosterone.

“We didn’t expect free testosterone to be an independent predictor of recurrence,” co-author Linda M. Huynh, MS, clinical research coordinator and assistant specialist in the department of urology at University of California Irvine, told Urology Times during the AUA annual meeting in Chicago.

The study confirms that higher levels of free testosterone do not further the progression of prostate cancer, the authors say. Meanwhile, low levels of free testosterone may hasten time to biochemical recurrence following radical prostatectomy.

The relationship between testosterone and prostate cancer has long been a source of controversy. For years, researchers believed testosterone replacement therapy increased men’s chances of developing prostate cancer. Now, some new studies are exploring whether testosterone replacement therapy could reduce the risk of aggressive prostate cancer. A study presented at the European Association of Urology annual congress in Barcelona found a 53% reduction in recurrence of prostate cancer among patients treated with testosterone therapy following robot-assisted radical prostatectomy.

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Meanwhile, literature supports the protective role that high levels of free testosterone play in preventing cardiovascular disease, diabetes mellitus, and other types of metabolic disorders, the University of California Irvine researchers say. They also point to recent data that show low levels of testosterone could be an independent risk factor for high-grade prostate cancer.

The authors sought to examine the relationship between free testosterone and biochemical recurrence in radical prostatectomy patients.

Under the direction of senior author Thomas Ahlering, MD, the group studied 800 patients who underwent robot-assisted radical prostatectomy from December 2009 through June 2018 for primary treatment of localized prostate cancer. Each patient was treated by a single surgeon, and cases from four surgeons were analyzed.

The authors measured patients’ total testosterone and free testosterone levels prior to surgery as well as 3 months after surgery. They also measured PSA levels, the pathologic stage of the cancer, and the pathologic grade. Only patients for whom each of these values was available were included for analysis.

The primary and secondary outcomes ­measured were biochemical recurrence (defined as two consecutive PSA values of 0.2 ng/dL or greater) and time to biochemical recurrence, respectively. Median follow-up time was 3.2 years following radical prostatectomy.

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About one in five patients (20.8%) experienced biochemical recurrence. Among these patients, preoperative free testosterone as well as free testosterone levels after 3 months were significantly lower than those of other patients in the study.

After adjusting for age, lower levels of free testosterone 3 months after radical prostatectomy independently predicted time to biochemical recurrence as well as the pathologic stage of the cancer.

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The study is a precursor to another study presented during the AUA annual meeting, “The Predictive Effect of Free Testosterone on Sexual Function Increases with Age.”

“We’re currently looking at a randomized controlled trial for free testosterone therapy to see if it improves sexual function and oncological outcomes,” Huynh told Urology Times.