J Urol
Low testosterone linked to higher‑grade progression during prostate cancer surveillance
A retrospective cohort study of 924 men (mean age, 63.6 years) with localized prostate cancer on active surveillance found that low baseline testosterone levels (≤300 ng/dL) were associated with a 61% increased risk of progression to grade group 3 or higher disease (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.03-2.51, p = 0.04) over a median follow-up of 46.1 months. Nearly 30% of men in the cohort had low testosterone at baseline. Importantly, low testosterone was not significantly associated with moderate progression to grade group 2 (HR, 1.23; 95% CI, 0.93-1.64, p=0.15), suggesting a specific relationship with higher-grade disease progression. Authors note that future studies should focus on prospective validation to clarify the biological relationship between androgens and prostate cancer progression, underscoring the need for more definitive evidence.
Clinical takeaway: Consider measuring baseline testosterone in men being evaluated for active surveillance, as levels ≤300 ng/dL may identify patients at higher risk for progression to grade group 3 or higher disease who warrant closer monitoring or discussion of earlier definitive treatment.
Source:
Lawen T, et al. (2026, February 24). J Urol. Low Testosterone Levels and Grade Group Progression Among Localized Prostate Cancer Patients on Active Surveillance: A Retrospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/41662578/