The testosterone conundrum: The putative relationship between testosterone levels and prostate cancer

Background: The controversy surrounding the relationship between testosterone and prostate cancer has existed for decades. The literature surrounding this topic is confusing and at times contradictory. There is no level-one quality evidence that confirms or refutes the relationship between either high or low serum testosterone levels and the subsequent development of prostate cancer. This commentary aims to review the issues involved and to provide an interpretation as to the causes of the confusion and to provide a framework for ongoing discussion and investigation. Materials and methods: A Medline and PubMed search was conducted using search terms: testosterone levels and prostate cancer to identify pertinent literature. Results: There is no consistent evidence that a single testosterone level is predictive of prostate cancer risk. Conclusion: The development of prostate cancer is a complex biologic process potentially involving genetics,dietary, life style and hormonal factors. Serum testosterone levels do not accurately reflect the internal prostatic milieu. Finally, if testosterone levels are to be considered in the etiology of prostate cancer they should be measured and interpreted on a chronic basis with multiple measurements over a period of years. (C) 2016 Elsevier Inc. All rights reserved.