Original Study| Volume 15, ISSUE 6, e1107-e1115, December 2017

Testosterone Reduction of ≥ 480 ng/dL Predicts Favorable Prognosis of Japanese Men With Advanced Prostate Cancer Treated With Androgen-Deprivation Therapy

Published:August 02, 2017DOI:



      Reductions in testosterone concentration play a significant role in the treatment of prostate cancer. We studied the role of testosterone as a prognostic marker for advanced prostate cancer (stage C or higher) treated with primary androgen-deprivation therapy (ADT).

      Patients and Methods

      A total of 348 patients were treated using ADT as first-line therapy for prostate cancer at Chiba University Hospital between 1999 and 2016. Of these, 222 patients with advanced prostate cancer (stage C or higher) were enrolled onto this study. The prognostic values of serum testosterone level and other clinical factors were evaluated in association with prostate-specific antigen (PSA), progression-free survival during first-line therapy, and overall survival.


      Median age was 73 years. PSA at baseline was 86 ng/mL. Gleason scores of ≤ 6, 7, 8, and ≥ 9 were seen in 2.3%, 19.4%, 21.2%, and 41.9%, respectively. Mean follow-up was 60.5 months. Median testosterone at baseline was 482 ng/dL and nadir testosterone was 13 ng/dL. No variable associated with testosterone predicted progression-free survival. With regard to overall survival, multivariate analysis identified nadir testosterone ≤ 20 ng/dL (hazard ratio = 0.44, P = .026) and testosterone reduction ≥ 480 ng/dL (hazard ratio = 0.35, P = .030) as independent prognostic factors. With regard to progression-free survival, multivariate analysis identified nadir PSA ≤ 0.1 ng/mL (hazard ratio = 3.07, P < .001), presence of lymph node metastasis (hazard ratio = 1.67, P = .017), and time to nadir PSA (hazard ratio = 0.30, P < .001) as independent prognostic factors.


      Our data suggested both nadir testosterone (< 20 ng/dL; P = .026) and testosterone reduction (≥ 480 ng/dL; P = .030) to be key prognostic factors for primary ADT in advanced prostate cancer in Japanese men.


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        • Cancer Registry and Statistics
        Cancer Information Service, National Cancer Center, Japan. Cancer mortality, 1958-2014.
        (Available at:) (Accessed: July 29, 2016)
        • Oefelein M.G.
        • Feng A.
        • Scolieri M.J.
        • Ricchiutti D.
        • Resnick M.I.
        Reassessment of the definition of castrate levels of testosterone: implications for clinical decision making.
        Urology. 2000; 56: 1021-1024
        • van der Sluis T.M.
        • Bui H.N.
        • Meuleman E.J.
        • et al.
        Lower testosterone levels with luteinizing hormone-releasing hormone agonist therapy than with surgical castration: new insights attained by mass spectrometry.
        J Urol. 2012; 187: 1601-1606
        • Kamada S.
        • Sakamoto S.
        • Ando K.
        • et al.
        Nadir testosterone after long-term followup predicts prognosis in patients with prostate cancer treated with combined androgen blockade.
        J Urol. 2015; 194: 1264-1270
        • Klotz L.
        • O'Callaghan C.
        • Ding K.
        • et al.
        Nadir testosterone within first year of androgen-deprivation therapy (ADT) predicts for time to castration-resistant progression: a secondary analysis of the PR-7 trial of intermittent versus continuous ADT.
        J Clin Oncol. 2015; 33: 1151-1156
        • Lane B.R.
        • Stephenson A.J.
        • Magi-Galluzzi C.
        • Lakin M.M.
        • Klein E.A.
        Low testosterone and risk of biochemical recurrence and poorly differentiated prostate cancer at radical prostatectomy.
        Urology. 2008; 72: 1240-1245
        • Schatzl G.
        • Madersbacher S.
        • Thurridl T.
        • et al.
        High-grade prostate cancer is associated with low serum testosterone levels.
        Prostate. 2001; 47: 52-58
        • Hoffman M.A.
        • DeWolf W.C.
        • Morgentaler A.
        Is low serum free testosterone a marker for high grade prostate cancer?.
        J Urol. 2000; 163: 824-827
        • Isom-Batz G.
        • Bianco F.J.
        • Kattan M.W.
        • Mulhall J.P.
        • Lilja H.
        • Eastham J.A.
        Testosterone as a predictor of pathological stage in clinically localized prostate cancer.
        J Urol. 2005; 173: 1935-1937
        • Imamoto T.
        • Suzuki H.
        • Fukasawa S.
        • et al.
        Pretreatment serum testosterone level as a predictive factor of pathological stage in localized prostate cancer patients treated with radical prostatectomy.
        Eur Urol. 2005; 47: 308-312
        • Massengill J.C.
        • Sun L.
        • Moul J.W.
        • et al.
        Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy.
        J Urol. 2003; 169: 1670-1675
        • Yamamoto S.
        • Yonese J.
        • Kawakami S.
        • et al.
        Preoperative serum testosterone level as an independent predictor of treatment failure following radical prostatectomy.
        Eur Urol. 2007; 52: 696-701
        • Morote J.
        • Orsola A.
        • Planas J.
        • et al.
        Redefining clinically significant castration levels in patients with prostate cancer receiving continuous androgen deprivation therapy.
        J Urol. 2007; 178: 1290-1295
        • Fizazi K.
        • Tran N.
        • Fein L.
        • et al.
        Abiraterone plus prednisone in metastatic, castration-sensitive prostate cancer.
        N Engl J Med. 2017; 377: 352-360
        • James N.D.
        • de Bono J.S.
        • Spears M.R.
        • et al.
        Abiraterone for prostate cancer not previously treated with hormone therapy.
        N Engl J Med. 2017; 377: 338-351
        • Sweeney C.J.
        • Chen Y.H.
        • Carducci M.
        • et al.
        Chemohormonal therapy in metastatic hormone-sensitive prostate cancer.
        N Engl J Med. 2015; 373: 737-746
        • Kongsted P.
        • Svane I.M.
        • Lindberg H.
        • Sengelov L.
        Predictors of chemotherapy-induced toxicity and treatment outcomes in elderly versus younger patients with metastatic castration-resistant prostate cancer.
        Clin Genitourin Cancer. 2016; 14: e559-e568
        • Droz J.P.
        • Efstathiou E.
        • Yildirim A.
        • et al.
        First-line treatment in senior adults with metastatic castration-resistant prostate cancer: a prospective international registry.
        Urol Oncol. 2016; 34: 234.e21-234.e29
        • Schiavi R.C.
        • White D.
        • Mandeli J.
        Pituitary–gonadal function during sleep in healthy aging men.
        Psychoneuroendocrinology. 1992; 17: 599-609
        • Regis L.
        • Planas J.
        • Carles J.
        • et al.
        Free Testosterone during androgen deprivation therapy predicts castration-resistant progression better than total testosterone.
        Prostate. 2017; 77: 114-120