A Study of association of low serum testosterone and prostate cancer behaviour.

Arun Prasad, K (2014) A Study of association of low serum testosterone and prostate cancer behaviour. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Prostate cancer is one amongst the most common medical diseases affecting elderly men. Carcinoma of the prostate is being the most common non-cutaneous cancer diagnosed in American male population. The lifetime risk of prostatic carcinoma is 16.7 % and the risk of death during the entire lifetime is around 2.6% for men in United States but the overall lifetime risk of death due to prostate malignancy is low in comparison to lifetime risk of diagnosis. In developed countries carcinoma of the prostate gland is more common in the elderly male population compared with younger men. Around 15% of men diagnosed to have cancer of the prostate in developed world when compared to only about 4% of men in developing nations. The association of cancer prostate and serum testosterone is known for the past few decades. The benefits of surgical castration and the role of estrogen treatment on the management of metastatic cancer prostate was assessed since olden days (Huggins and Hodges, 1941).They earlier demonstrated the clinical beneficial effects of androgen suppression therapy in the management of metastatic (advanced) cancer prostate. The androgen suppression benefits are recently extended in the management of even in non metastatic prostate cancer patients and recurrent prostate cancer after definitive management. Again there is a role for hormonal therapy in neoadjuvant settings like before radical prostatectomy which resulted in decrease in serum PSA, Shrinkage of prostate tumor volume and reduction in the rate of positive surgical margins. The reduction in prostate volume following neoadjuvant hormonal therapy is more in peripheral zone compared to central zone. Prostate cancer is a hormone dependant cancer and the clinical course of prostate cancer varies with individual and again it varies within the individual in relationship to serum testosterone levels. The present study is to find out the role of low serum testosterone level in predicting prostate cancer behaviour in comparison with normal serum testosterone level patients and to find out the relationship between low serum testosterone level and serum PSA levels in TRUS biopsy proven cancer prostate patients. AIM AND OBJECTIVES : The primary aim and objective of our study is to determine the association of low serum testosterone and prostate cancer behaviour and with a Secondary objective to determine the relationship of serum PSA level in cancer prostate patients with low serum testosterone. MATERIALS AND METHODS : Informed consent was obtained from all patients. All TRUS biopsy proven cancer prostate patients were enrolled to a maximum number of 100. All details were recorded as per the proforma (Appendix-3). Blood investigations like serum PSA, serum testosterone and other baseline investigations were obtained. The serum determinations of Testosterone obtained between 7 – 9.30 am. The serum Testosterone levels measured by appropriate standard protocols. Patients were divided into two groups based on the serum testosterone levels. Patients with low serum testosterone levels (< 250 ng/dl) were categorized as Group A and patients with normal serum testosterone levels (> 250 ng/dl) were categorized as Group B and and the findings between two groups will be compared. Inclusion criteria: All newly diagnosed prostate cancer (TRUS guided biopsy proven) patients with age more than 40 years in our institution were enrolled. Exclusion Criteria: Patients already on testosterone replacement therapy, Patients on other hormonal therapy, Men taking medications known to lower serum PSA level (Finasteride or Dutasteride). The patient age and serum PSA were compared with the help of Student's t-test in the low- and normal serum testosterone groups. Chi-square test (Pearson’s) was applied to compare the prostate cancer parameters between low and normal serum testosterone patients. Statistical analyses were done using software SPSS version 17.0. A p value equal to or below 0.05 was taken as statistically significant. CONCLUSION : Low total serum testosterone is associated with higher proportion of predominant Gleason pattern 4, an indicator of aggressive prostate cancer. Patients with low serum testosterone levels were associated with an increased serum PSA levels compared with patients in normal serum testosterone levels. Patients with low testosterone who were managed by radical prostatectomy had a higher proportion of positive surgical margin, extra capsular extension and seminal Vesical invasion suggesting an aggressive prostate cancer behaviour. Preoperative total testosterone should be routinely added to serum prostate specific antigen estimation to improve prostate cancer management.

Item Type: Thesis (Masters)
Uncontrolled Keywords: low serum testosterone ; prostate cancer behaviour.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 10 Aug 2017 02:24
Last Modified: 10 Aug 2017 06:10
URI: http://repository-tnmgrmu.ac.in/id/eprint/2552

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