Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance Ignacio F. San Francisco, Pablo A. Rojas, William C. DeWolf* and Abraham Morgentaler* Departamento de Urología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile and *Division of Urological Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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 (CIs) were obtained using univariate logistic regression. Receiver–operator characteristic curves were generated to determine the investigated testosterone thresholds. Kaplan–Meier curves were used to estimate time to disease reclassification. A Cox 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
Introduction Active surveillance (AS) has become an increasingly accepted treatment option for men with low-risk prostate cancer (PCa), offering a low cancer-specific mortality (0–1%) [1]; however, approximately a third of these men will eventually progress and require definitive treatment [2–4]. The ability to identify men at increased risk of progression would be of considerable clinical value. We have previously described significant predictors of progression in a cohort of patients on AS [4], of whom 30% had disease progression over a mean follow-up of 2.4 years. These included PSA density >0.08 ng/mL/cc, a family history of PCa and PSA velocity. In the present study we examine whether baseline serum androgen concentrations predict progression in men undergoing AS. We note that there is a growing belief that the term ‘progression’ should be replaced by ‘disease reclassification’ as the misclassification rate of Gleason 6 prostate biopsies at prostatectomy [5] is identical © 2014 The Authors BJU International © 2014 BJU International | doi:10.1111/bju.12682 Published by John Wiley & Sons Ltd. www.bjui.org
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
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 (CIs) were obtained using univariate logistic regression. Receiver–operator characteristic curves were generated to determine the investigated testosterone thresholds. Kaplan–Meier curves were used to estimate time to disease reclassification. A Cox 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
Introduction Active surveillance (AS) has become an increasingly accepted treatment option for men with low-risk prostate cancer (PCa), offering a low cancer-specific mortality (0–1%) [1]; however, approximately a third of these men will eventually progress and require definitive treatment [2–4]. The ability to identify men at increased risk of progression would be of considerable clinical value. We have previously described significant predictors of progression in a cohort of patients on AS [4], of whom 30% had disease progression over a mean follow-up of 2.4 years. These included PSA density >0.08 ng/mL/cc, a family history of PCa and PSA velocity. In the present study we examine whether baseline serum androgen concentrations predict progression in men undergoing AS. We note that there is a growing belief that the term ‘progression’ should be replaced by ‘disease reclassification’ as the misclassification rate of Gleason 6 prostate biopsies at prostatectomy [5] is identical © 2014 The Authors BJU International © 2014 BJU International | doi:10.1111/bju.12682 Published by John Wiley & Sons Ltd. www.bjui.org
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
