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Vol. 39. Issue 9.
Pages 573-581 (November 2015)
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Vol. 39. Issue 9.
Pages 573-581 (November 2015)
Review article
Behavior of total and free serum testosterone as a predictor for the risk of prostate cancer and its aggressiveness
Comportamiento de la testosterona total y libre en suero como predictores del riesgo de cáncer de próstata y de su agresividad
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L. Regisa,
Corresponding author
lucasregis@gmail.com

Corresponding author.
, J. Planasa,b, A. Celmaa,b, I.M. de Torresb,c,d, R. Ferrerd, J. Morotea,b,e
a Servicio de Urología, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Unidad Institut de Recerca Vall d’Hebron, Hospital Universitari Vall d’Hebron, Barcelona, Spain
c Servicio de Anatomía Patológica, Hospital Universitario Vall d¿Hebron, Barcelona, Spain
d Servicio de Bioquímica, Hospital Universitario Vall d¿Hebron, Barcelona, Spain
e Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain
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Tables (3)
Table 1. Main studies that found an association between total testosterone and/or free testosterone and an increase in the risk of prostate cancer.
Table 2. Main studies that did not find an association between the risk of prostate cancer or agressiveness and total and/or free testosterone.
Table 3. Major studies that found an association between the aggressiveness of prostate cancer and total testosterone and/or free testosterone.
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Abstract
Context

Serum testosterone is mostly bound to the sex hormone-binding globulin and albumin. A small metabolically active part is present in the form of free testosterone (FT). The relationship between serum total testosterone (TT) levels and prostate carcinogenesis is debated. Our hypothesis is that the serum FT concentration is more closely associated with the risk of prostate cancer (PC) and its aggressiveness than TT.

Objective

To analyze the scientific evidence that relates serum TT and/or FT levels with the diagnosis of PC and its aggressiveness.

Acquisition of evidence

A systematic review was conducted in PubMed up to January 2015 using the following mesh terms: prostate cancer, sex hormone, androgen, testosterone and free testosterone.

Synthesis of the evidence

We found 460 publications, 124 of which were reviewed to analyze the evidence. The relationship between serum TT levels and the diagnosis of PC and its aggressiveness is highly heterogeneous. The variability in the design of the studies, the quantification methods and other variables could explain this heterogeneity. In a number of studies that evaluated the estimated or measured FT, the evidence remains equally conflicting.

Conclusions

Based on the current evidence, we cannot recommend the measurement of serum TT and/or TL levels for the diagnosis of PC or for assessing its aggressiveness.

Keywords:
Prostate cancer
Diagnosis
Aggressiveness
Androgens
Testosterone
Free testosterone
Resumen
Contexto

La testosterona en suero está unida mayoritariamente a la hormona transportadora de esteroides sexuales y a la albúmina, existiendo una pequeña parte metabólicamente activa en forma de testosterona libre (TL). La relación entre los niveles séricos de testosterona total (TT) y la carcinogénesis prostática es controvertida. Nuestra hipótesis es que la concentración de TL en suero se relacionaría mejor que la de TT con el riesgo de cáncer de próstata (CP) y su agresividad.

Objetivo

Analizar la evidencia científica que ha relacionado los niveles séricos de TT y/o TL con el diagnóstico de CP y su agresividad.

Adquisición de la evidencia

Se ha realizado una revisión sistemática en PubMed hasta enero de 2015, utilizando los términos MeSH: prostate cancer, sex hormone, androgen, testosterone, free testosterone.

Síntesis de la evidencia

Se encontraron 460 publicaciones, de las cuales se han revisado 124 para analizar la evidencia. La relación entre niveles séricos de TT y el diagnóstico de CP y su agresividad es muy heterogénea. La variabilidad en el diseño de los estudios, en los métodos de cuantificación y otras variables puede justificar esta heterogeneidad. En algunos estudios en los que se ha evaluado la TL calculada o determinada la evidencia sigue siendo igualmente contradictoria.

Conclusiones

La evidencia actual no permite recomendar la determinación sérica de TT y/o TL en el proceso diagnóstico del CP ni en la evaluación de su agresividad.

Palabras clave:
Cáncer de próstata
Diagnóstico
Agresividad
Andrógenos
Testosterona
Testosterona libre

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