title: Behavior of total and free serum testosterone as a predictor for the risk of prostate cancer and its aggressiveness.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  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.
authors.affiliation: Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, España. Electronic address: lucasregis@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Regis
authors.affiliation: Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Planas
authors.affiliation: Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Celma
authors.affiliation: Unidad Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Barcelona, España; Servicio de Anatomía Patológica, Hospital Universitario Vall d́Hebron, Barcelona, España; Servicio de Bioquímica, Hospital Universitario Vall d́Hebron, Barcelona, España.
authors.forename: I M
authors.initials: IM
authors.lastname: de Torres
authors.affiliation: Servicio de Bioquímica, Hospital Universitario Vall d́Hebron, Barcelona, España.
authors.forename: R
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Barcelona, España; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Morote
mesh_terms: D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D018570:Risk Assessment; D013739:Testosterone / Q000097:blood*
chemical_list: D013739:Testosterone
keywords: Aggressiveness; Agresividad; Androgens; Andrógenos; Cáncer de próstata; Diagnosis; Diagnóstico; Free testosterone; Prostate cancer; Testosterona; Testosterona libre; Testosterone