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Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance
Author(s) -
San Francisco Ignacio F.,
Rojas Pablo A.,
DeWolf William C.,
Morgentaler Abraham
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12682
Subject(s) - testosterone (patch) , medicine , prostate cancer , hazard ratio , logistic regression , confidence interval , odds ratio , cohort , endocrinology , gynecology , cancer
Objective To determine whether total testosterone and free testosterone levels predict disease reclassification in a cohort of men with prostate cancer ( PCa ) on active surveillance ( AS ). Patients and Methods Total testosterone and free testosterone concentrations were determined at the time the men began the AS protocol. Statistical analysis was performed using Student's t ‐test and a chi‐squared test to compare groups. Odds ratios ( ORs ) with 95% confidence intervals ( CI s) were obtained using univariate logistic regression. Receiver–operator characteristic curves were generated to determine the investigated testosterone thresholds. K aplan– M eier curves were used to estimate time to disease reclassification. A C ox proportional hazard regression model was used for multivariate analysis. Results A total of 154 men were included in the AS cohort, of whom 54 (35%) progressed to active treatment. Men who had disease reclassification had significantly lower free testosterone levels than those who were not reclassified (0.75 vs 1.02 ng/dL, P = 0.03). Men with free testosterone levels <0.45 ng/dL had a higher rate of disease reclassification than patients with free testosterone levels ≥0.45 ( P = 0.032). Free testosterone levels <0.45 ng/dL were associated with a several‐fold increase in the risk of disease reclassification ( OR 4.3, 95% CI 1.25–14.73). Multivariate analysis showed that free testosterone and family history of PCa were independent predictors of disease reclassification. Conclusions Free testosterone levels were lower in men with PCa who had reclassification during AS . Men with moderately severe reductions in free testosterone level are at increased risk of disease reclassification.