High-grade prostate cancer is associated with low serum testosterone levels

BACKGROUND. The aim of this study was to assess whether low serum testoster one levels in men with newly diagnosed prostate cancer have an association to the endocrine status, prostate-specific antigen (PSA) levels, Gleason sc ore, and androgen receptor expression. METHODS. Besides a full clinical work-up, the following hormones were quant ified in men with newly diagnosed prostate cancer by serum analysis: total testosterone, human luteinising hormone (hLH), human follicle stimulating h ormone (hFSH), estradiol, and dehydroepian-drostendione (DHEA). In a subgro up of men, androgen receptor expression was determined immunohistochemicall y. RESULTS. One hundred and fifty six patients (65.7 +/- 8.5 yrs) with a mean PSA of 29.8 ng/ml (median: 7.4 ng/ml) were analysed. Fifty-two patients (33 %) had a partial androgen deficiency (serum testosterone <3.0 ng/ml). These men had lower hLH (3.3 vs. 5.9 mIU/ml), hFSH (6.2 vs. 8.4 mIU/ml), and est radiol (18.8 vs. 29.1 pg/ml) serum levels. Mean Gleason score was higher (7 .4 vs. 6.2) in men with a low serum testosterone, PSA-levels were lower (25 .3 vs. 31.9 ng/ml). Mean testosterone levels decreased from 4.1 +/- 1.7 ng/ ml in patients with Gleason scores 15 to 2.8 +/- 2.7 ng/ml with Gleason sco res greater than or equal to 8. Androgen receptor expression was higher in patients with low serum testosterone. CONCLUSIONS. Patients with high Gleason score prostate cancer have lower te stosterone and estradiol serum levels. The fact that gonadotropins were low er in parallel suggests a tumor-mediated suppression of the hypothalamic-pi tuitary-gonadal hormone axis particularly in men with high Gleason score ru mours. Prostate 47:52-58, 2001. (C) 2001 Wiley-Liss, Inc.