Both High and Low Serum Total Testosterone Levels Indicate Poor Prognosis in Patients with Prostate Cancer.

BACKGROUND/AIM: Androgen-androgen receptor (AR) signal is known as a powerful driver of prostate cancer progression. We previously reported the limitation of prostate-specific antigen (PSA) at diagnosis as a prognostic biomarker of prostate cancer. Although serum total testosterone (TT) level has been reported as a prognostic biomarker for prostate cancer, its usability is still controversial. We examined the potential and characteristics of TT as a biomarker. PATIENTS AND METHODS: Serum TT levels of patients who underwent prostate biopsy were measured, and prostate cancer-specific survival (PCaSS), overall survival (OS), and the correlation between staging and serum TT level were analyzed. RESULTS: Of 379 biopsied patients, 255 were diagnosed with prostate cancer. The patients were divided into five groups according to their serum TT levels; patients with serum TT levels of <2 or ≥8 ng/ml (ENDs) had worse PCaSS and OS compared with those with middle serum TT levels between 2 and 8 ng/ml (MIDs). Moreover, ENDs showed a tendency of having castration-resistant cancer with advanced stage (T4 or N1 or M1). The TNM stage in ENDs was significantly higher than in MIDs. CONCLUSION: Although low serum TT level has been reported to indicate worse outcome in patients with prostate cancer, this study showed that both low as well as high serum TT levels indicate poor prognosis.