
First-of-its-kind study on 266 men found 20% have higher levels of the hormone within the vessels surrounding the prostate.
Drawing blood from the arms of prostate cancer patients to evaluate for testosterone just isn’t generally useful for determining risk of outcomes after radical prostatectomy and might underreport levels of testosterone surrounding the prostate, based on a study by Nima Sharifi, M.D., scientific director of the Desai Sethi Urology Institute and a researcher at Sylvester Comprehensive Cancer Center on the University of Miami Miller School of Medicine.
Findings from the newly published study in The Journal of Clinical Investigation suggest a big proportion of men have testosterone concentrations which are much higher in and across the prostate than traditional blood draws suggest. And this elevated exposure near the prostate increases the chance of poor outcomes after surgical removal of the prostate gland.
“I describe this as ‘sneaky testosterone.’ It’s sneaky because we don’t see it — we don’t appreciate it — just by general blood,” said Dr. Sharifi, who conducted much of this research while at Cleveland Clinic, before joining Desai Sethi Urology Institute earlier this 12 months.
The final assumption today is that clinicians can assess the prostate’s testosterone exposure by measuring the extent with blood drawn from the arm. High testosterone levels could have implications on prostate cancer development and progression.
Significant differences in testosterone concentration
On this first-of-its-kind study, Miller School and Cleveland Clinic researchers assessed 266 men with prostate cancer undergoing radical prostatectomies between 2014 and 2021. They studied not only general blood and prostate tissue specimens but in addition vessels surrounding the prostate.
Dr. Sharifi and colleagues found that 20% of the lads had testosterone concentrations in vessels across the prostate that were twice as high as within the blood from their arms, with 5% of the lads having 10 times the concentration in vessels surrounding the prostate.
This implies that some men have a brief circuit going from gonadal circulation to the prostate. Most significantly, men who had this sneaky testosterone physiology had worse long-term outcomes after that they had surgery for prostate cancer.”
Dr. Nima Sharifi, M.D., scientific director of the Desai Sethi Urology Institute and researcher at Sylvester Comprehensive Cancer Center on the University of Miami Miller School of Medicine
Associations with varioceles
There are other potential implications of the research, including in the world of infertility, he said.
“This sneaky testosterone physiology might be common to varicoceles, a condition where the forward flow of the blood from the testes is impeded and this effectively creates back flow. Varicoceles is thought to be related to infertility,” Dr. Sharifi said. “Our study tells us that there could also be other associations of varicoceles, potentially directly linking varicoceles to an aggressive type of prostate cancer.”
The identification of men with sneaky testosterone physiology adds latest information to think about within the prognoses of men with prostate cancer and has broad implications for assessing risk in other diseases of the prostate, based on study creator Eric A. Klein, M.D., emeritus chair of Cleveland Clinic’s Glickman Urological and Kidney Institute.
“For years, testosterone, T, and its derivative, dihydrotestosterone, DHT, have been known to affect prostate development and drive prostate cancer. Nonetheless, peripheral blood T levels don’t correlate with prostate cancer risk or severity,” Dr. Klein said. “This study suggests this is perhaps because some men have veins that directly link the prostate to the testes, enabling higher T and DHT levels within the prostate, potentially resulting in aggressive tumors. These venous shunts bypass peripheral circulation, meaning arm vein blood samples don’t reflect T and DHT exposure to the prostate.
This and future studies may lead to alternative treatment strategies for urological diseases which are impacted by sneaky testosterone physiology.”
Mohammad Alyamani, Ph.D., research assistant professor on the Miller School, first creator on the study