Serum testosterone is not a correlate of prostate cancer lymph node involvement, but does predict biochemical failure for lymph node positive disease

Previously we found that serum testosterone (serum-T) correlated with the d evelopment of distant metastasis in patients with clinically localized pros tate cancer treated with radiotherapy. In this report, the relationship of serum-T to lymph node positivity and to patient outcome for patients with r egional lymph node involvement treated with androgen ablation alone was inv estigated. Serum-T was available in 514 of 854 men with clinically localize d prostate cancer who underwent pelvic lymphadenectomy at M.D. Anderson Can cer Center between 1984 and 1993. Pretreatment prostatic acid phosphatase ( PAP) and prostate specific antigen (PSA) were assayed in 98% and 95% of pat ients, respectively. Androgen ablation was achieved via orchiectomy or a lu teinizing hormone releasing hormone agonist. Median follow-up was 66 months for the node positive subgroup (n = 92). Serum-T did not correlate with pa lpable stage, Gleason scare, pretreatment PSA, or lymph node involvement. A ge less than or equal to 60 years and pretreatment PAP > 0.8 mU/ml correlat ed significantly with higher serum-T. In lymph node positive patients treat ed with androgen ablation, higher serum-T levels corresponded to both pretr eatment PSA > 10 ng/ml and PAP > 0.8 mU/ml. Serum-T predicted for biochemic al failure, but not metastatic relapse or overall survival. Actuarial 5-yea r biochemical failure rate was 73% for serum T > 500 ng/dl and 57% for seru m-T less than or equal to 500 (p = 0.009). Multivariate analysis showed ser um-T to be an independent correlate of rising PSA, both as a continuous (p = 0.001) or categorical (p = 0.037) variable. Serum-T did not significantly correlate with lymph node positivity, and therefore is not a marker for re gional disease spread. However, serum-T was significantly associated with b iochemical failure in node-positive patients treated with androgen ablation alone. (C) 1999 Elsevier Science Inc. All rights reserved.