Portal de Periódicos da CAPES

LOW TESTOSTERONE LEVELS ARE RELATED TO POOR PROGNOSIS FACTORS IN MEN WITH PROSTATE CANCER PRIOR TO TREATMENT

2012; Wiley; Volume: 110; Issue: 11b Linguagem: Inglês

10.1111/j.1464-410x.2012.11243.x

1464-410X

Abraham Morgentaler,

Prostate Cancer Diagnosis and Treatment

In this study by García-Cruz et al., the authors provide further evidence supporting poor prognostic features of prostate cancer (PCa) with lower serum testosterone concentrations. Specifically, in a group of men undergoing prostate biopsy low testosterone was associated with greater D'Amico risk of progression, high Gleason scores, increased risk of bilaterality and higher overall tumour burden. It is remarkable how far the literature has come in fleshing out this troubling relationship between low testosterone and PCa since the original finding in 1996 linking low testosterone with PCa, challenging the traditional orthodoxy that high testosterone is responsible for PCa [1]. Studies from around the world have shown that low testosterone is associated with increased risk of PCa on biopsy, high Gleason scores, increased risk of seminal vesicle invasion, and increased risk of biochemical recurrence [2]. Yet old ideas die hard, and there continues to be significant resistance to accepting the idea that it is low testosterone and not high testosterone that is repeatedly found in association with poor prognostic features of PCa. Young investigators should take note of the opportunities presented by this paper and related literature. For 70 years since the work of Huggins there has been almost no attempt to address the questions presented here. What is the nature of the relationship between low testosterone and aggressive PCa? Is it causal? If so, in which direction, i.e. is it PCa that lowers testosterone or does low testosterone create an environment that contributes to development of PCa? Perhaps there is no causal relationship at all. By moving past the tired dogma of many decades there now exists the possibility of discovering something truly new and valuable in the field of prostate cancer.