A new retrospective cohort study suggests that low testosterone levels may predict the progression to high-grade prostate cancer in men undergoing active surveillance for localized disease.
Researchers evaluated 924 men enrolled in an active surveillance program between 2005 and 2024. They found that men with baseline testosterone levels of 300 ng/dL or lower had a 61% higher risk of developing Grade Group 3 or higher disease compared to those with higher testosterone levels. This association remained strong even after adjusting for age, PSA density, and biopsy tumor volume.
Interestingly, low testosterone was not linked to progression to the intermediate Grade Group 2, suggesting a specific connection to more biologically aggressive disease.
The authors call for prospective studies to confirm these findings and explore the biological mechanisms. As active surveillance becomes more common, measuring testosterone at baseline could help identify men at greater risk of aggressive progression.