Behavior of total and free serum testosterone as a predictor for the risk of prostate cancer and its aggressiveness

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: Aggressiveness; Agresividad; Androgens; Andrógenos; Cáncer de próstata; Diagnosis; Diagnóstico; Free testosterone; Prostate cancer; Testosterona; Testosterona libre; Testosterone.