Baseline Testosterone Levels in Men with Clinically Localized High-Risk Prostate Cancer Treated with Radical Prostatectomy with or without Neoadjuvant Chemohormonal Therapy (Alliance)

James A Eastham ¹,
Glenn Heller ¹,
David W Hillman ²,
Olwen M Hahn ³,
J Kellogg Parsons ⁴,
James L Mohler ⁵,
Eric J Small ⁶,
Michael Morris ¹

¹ Memorial Sloan Kettering Cancer Center, New York, USA ² Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota, USA ³ Alliance Protocol Operations Office, University of Chicago, Chicago, Illinois, USA ⁴ Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, California, USA ⁵ Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA ⁶ Medical Center-Mount Zion, University of California San Francisco, San Francisco, California, USA

Abstract

Publication: Journal of Urology, March 2021

https://www.auajournals.org/doi/10.1097/JU.0000000000001716

Purpose

Men with low serum testosterone at the time of prostate cancer diagnosis are frequently considered to have more aggressive disease. We examined treatment outcomes in men with clinically localized high-risk cancer to determine if baseline testosterone level identified men at higher risk for cancer progression after treatment.

Materials and Methods

Alliance/CALGB 90203 randomized men with clinically localized high-risk prostate cancer to radical prostatectomy (RP) alone or neoadjuvant chemohormonal therapy and RP. Men with available baseline testosterone levels who had not received androgen deprivation prior to study enrollment were studied (n=656). Testosterone level was examined as a continuous variable, as quartiles, and separately in men with an absolute testosterone level above/below 150 ng/dL. Outcomes evaluated were overall survival and event free survival with events defined by biochemical recurrence, secondary treatment, prostate cancer metastasis, and death.

Results

We were unable to demonstrate a difference between baseline serum testosterone level, measured as a continuous variable, as quartiles, or as a dichotomous variable (above/below 150 ng/dL), with the outcomes measured. This finding was observed in both arms of the study.

Conclusions

Baseline serum testosterone level did not predict outcomes in men with clinically localized high-risk prostate cancer treated with RP alone or neoadjuvant chemohormonal therapy and RP.