The role of endogenous testosterone in relationship with low-and intermediate-risk prostate cancer: a systematic review

Sep 21, 2026

An enduring debate examines whether elevated endogenous testosterone relates to prostate cancer. This systematic review evaluates current knowledge on endogenous testosterone’s role in diagnosis and treatment among low- and intermediate-risk prostate cancer. Searches in PubMed, Web of Science, and Scopus used predefined diagnostic and treatment keywords; two investigators applied PRISMA-based independent screening. From 105 records to 10 eligible studies, findings cover risk-class association, testosterone density versus tumor load, and testosterone links to tumor upgrading and upstaging, while results remain conflicting and need further studies.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Search strategy and study selection (PRISMA)

Included study topics and findings

Context of prostate cancer risk classification

Methods and eligibility criteria

Prostate Cancer Open Access INVITED REVIEW The role of endogenous testosterone in relationship with low-and intermediate-risk prostate cancer: a systematic review Antonio Benito Porcaro, Emanuele Serafin, Davide Brusa, Sonia Costantino, Claudio Brancelli, Maria Angela Cerruto, Alessandro Antonelli An enduring debate in research revolves around the association between elevated endogenous testosterone levels and prostate cancer. This systematic review is intended to assess the present understanding of the role of endogenous testosterone in the diagnosis and treatment of low-and intermediate-risk prostate cancer. Our search strategy was the following: (endogenous testosterone) AND (((low risk) OR (intermediate risk)) AND ((diagnosis) OR (treatment))) AND (prostate cancer); that was applied to PubMed, Web of Science, and Scopus databases to identify pertinent articles. Two investigators performed an independent selection following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The preliminary investigation detected 105 records, and 81 records remained after eliminating duplicates. Following the review of titles and abstracts, 71 articles were excluded. A comprehensive examination of the full text was conducted for 10 articles, excluding 3 of them. After revising the references of eligible articles, other 3 articles were included. We finally identified 10 suitable studies, including three main topics: (1) association between endogenous testosterone and European Association of Urology (EAU) risk classes; (2) association between endogenous testosterone density and the tumor load; and (3) association of endogenous testosterone with tumor upgrading and tumor upstaging. Actual literature about the impact of endogenous testosterone on low-and intermediate-risk prostate cancer is not numerous, but appears to be still conflicting. More investigations are needed to increase the consistency of the literature’s results. Asian Journal of Andrology (2024) 26 , 569–574; doi: 10.4103/aja202443; published online: 09 August 2024 Keywords: endogenous testosterone; intermediate-risk prostate cancer; low-risk prostate cancer INTRODUCTION Based on the guidelines set forth by the European Association of Urology (EAU), prostate cancer (PCa) ranks as the second most frequently diagnosed cancer in men, with a prevalence of 59% among those aged over 79 years, presenting a significant health concern for elderly males.1 Following diagnosis, patients are classified into prognostic groups (low- , intermediate- , and high-risk categories) based on D’Amico’s classification, which considers prostate-specific antigen (PSA) levels, International Society of Urological Pathology (ISUP) grade group, and clinical T from tumor, node, metastasis (TNM) classification, as suggested by guidelines. Various therapeutic choices are available for different risk categories, ranging from active surveillance (AS) to active interventions such as radical prostatectomy (RP) potentially coupled with extended pelvic lymph node dissection (ePLND), radiation therapy (RT), or brachytherapy.1,2 The precise reasons behind the development and advancement of PCa remain unknown.3 An enduring debate in research revolves around the association between elevated endogenous testosterone (ET) levels and PCa, with evidence indicating that this association could be negative, positive, or null.4,5 ET plays a crucial role in assessing conditions related to prostate growth, such as benign prostatic hyperplasia (BPH) or PCa.1 Numerous studies suggest that testosterone serves as a contributing factor promoting PCa in experimental research.3,6 The role of ET in inducing the development of PCa in humans is not clear6 as well as its contribution to determining the risk class of PCa and its implications in clinical practice. This systematic review is intended to assess the present understanding ofthe role ofET in the diagnosis and treatment of low-a

FAQs

What question does the systematic review address?

The review assesses the role of endogenous testosterone in the diagnosis and treatment of low- and intermediate-risk prostate cancer.

Which databases and search strategy were used?

The authors searched PubMed, Web of Science, and Scopus using a strategy combining endogenous testosterone with terms for low/intermediate risk, diagnosis/treatment, and prostate cancer.

How many studies were ultimately included, and what were the main topics?

Ten suitable studies were identified. They focus on endogenous testosterone and EAU risk classes, endogenous testosterone density and tumor load, and endogenous testosterone with tumor upgrading and upstaging.

Sep 21, 2026

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