title: Serum testosterone is associated with aggressive prostate cancer in older men: results from the Baltimore Longitudinal Study of Aging.
abstract: METHODS
  Prognosis (inception cohort).
  
  
  METHODS
  1b.
  
  
  OBJECTIVE
  To evaluate the relationship between testosterone levels and the development of high-risk prostate cancer, by prospectively examining serum androgen concentrations in a well-studied cohort, as the role of testosterone in prostate cancer progression is debated.
  
  
  METHODS
  The study comprised 781 men in the Baltimore Longitudinal Study of Aging who had sex steroid measurements before a diagnosis of prostate cancer, or at their last visit for those without cancer (no cancer, 636; cancer, not high risk, 109; cancer, high risk, 36). High-risk cancer was defined as death from prostate cancer, a prostate specific antigen (PSA) level of > or =20 ng/mL at diagnosis, or a Gleason score of > or =8. The hazard ratio (HR) of high-risk disease was determined using a Cox proportional hazards regression model with simple updating, and risk rates were stratified by age and tercile for androgens of interest based on the proportional hazards analyses.
  
  
  RESULTS
  The likelihood of high-risk prostate cancer doubled per unit (0.1) increase in the free testosterone index (FTI) for patients aged >65 years (HR 2.07, 95% confidence interval, CI, 1.01-4.23; P = 0.047); the likelihood for men aged < or =65 years was inversely related to the FTI (HR 0.96, 95% CI 0.35-2.6; P = 0.9). The risk rate per person-years increased from lowest to highest tercile of FTI for the oldest men (age >70 years) but this trend was not apparent among younger men.
  
  
  CONCLUSIONS
  Higher levels of serum free testosterone are associated with an increased risk of aggressive prostate cancer among older men. These data highlight the importance of prospective trials to insure the safety of testosterone-replacement therapy.
authors.affiliation: Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. philpierorazio@jhmi.edu
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Anna
authors.initials: A
authors.lastname: Kettermann
authors.forename: Dan L
authors.initials: DL
authors.lastname: Longo
authors.forename: E Jeffrey
authors.initials: EJ
authors.lastname: Metter
authors.forename: H Ballentine
authors.initials: HB
authors.lastname: Carter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D018450:Disease Progression; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000473:pathology*; D013739:Testosterone / Q000097:blood*
chemical_list: D013739:Testosterone