(UroToday.com) The 2025 South Central AUA annual meeting included a session on prostate cancer, featuring a presentation from Dr. Tarek Lawen discussing low serum testosterone level and biopsy grade group progression among men with prostate cancer on active surveillance. Hypogonadism, defined as low serum testosterone, is associated with increased rates of adverse pathology at radical prostatectomy.
However, the association between low testosterone levels and grade group progression among men with prostate cancer managed on active surveillance remains unclear. This study, presented at the 2025 South Central AUA annual meeting, evaluated whether hypogonadism present at the time of prostate cancer diagnosis is associated with grade group progression in men undergoing active surveillance for prostate cancer.
The investigators conducted a retrospective analysis of men on active surveillance at MD Anderson Cancer Center. The primary exposure was the first measured testosterone, hypothesizing that testosterone level ≤300 ng/dL (based on AUA Testosterone Deficiency guidelines), was associated with progression. Two outcomes of interest were defined: progression to grade group 2 or higher, or “extreme” progression to grade group 3 or higher. Multivariable Cox proportional hazards models were developed to evaluate the association between baseline testosterone level and progression:
- A base model (including testosterone and age)
- A clinical model (adding PSA density and biopsy tumor volume)
- A comprehensive model (further incorporating smoking status, BMI, and ethnicity)
A total of 924 patients were included, with a mean age of 63.6 years (SD 8.1 years) and a mean PSA of 4.7 ng/dL (SD 3.2 ng/dL). The mean baseline testosterone was 394 ng/dL (SD 160.4 ng/dL), and a total of 272 (29.4%) had a baseline testosterone of ≤ 300 ng/dL. At a median follow-up of 48.2 months (IQR 18 to 63 months), 214 (23.2%) patients had grade group 2 progression, and 83 (9.0%) had grade group 3:
In a Cox proportional hazards model accounting for clinical and patient factors, testosterone ≤300 ng/dL was associated with grade group 2 (HR 1.25, 95% CI 0.93-1.67, p = 0.13) and grade group 3 (HR 1.61, 95% CI 1.02-2.54, p = 0.04) progression. PSA density was the strongest predictor of grade group 2+ (HR 17.94, p < 0.001) and grade group 3+ (HR 30.78, -< 0.001) progression, suggesting that clinical factors may outweigh testosterone’s impact. Secondary analyses, including subgroups of patients with multiple testosterone values and assessing different population-based thresholds, demonstrated similar results (data not shown).
Dr. Lawen concluded his presentation discussing low serum testosterone level and biopsy grade group progression among men with prostate cancer on active surveillance with the following take-home points:
- This study demonstrated hypogonadism, defined as baseline testosterone ≤ 300 ng/dL, is associated with grade group 3 progression in a large cohort of men enrolled on active surveillance
- These findings, if validated, suggest that hypogonadism may be an independent risk factor for localized prostate cancer progression and may serve as a potential prognostic biomarker that may be evaluated in future studies
Presented by: Tarek Lawen, Urologic Oncology Fellow, MD Anderson Cancer Center, Houston, TX
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 South Central American Urological Association (AUA) Annual Meeting, Orlando, FL, Wed, Sept 10 – Sat, Sept 13, 2025.