Paradoxical effects associated with supranormal urinary testosterone excretion in premenopausal women with breast cancer: increased risk of postmastectomy recurrence and higher remission rate after ovariectomy.

Urinary testosterone excretion was measured in 18 normal premenopausal women, 80 women studied shortly after mastectomy for primary operable breast cancer, and 93 women with either metastatic breast cancer (77) or primary inoperable breast cancer (16) who were to be ovariectomized. Forty-two of the 93 were restudied after the ovariectomy. The control women showed a normal distribution of testosterone excretion, up to 12 micrograms daily; the postmastectomy patients showed a bimodal distribution, with 14 patients (17.5%) having values above 12 micrograms (up to 39 micrograms) daily. In the metastatic group, 24 of 77 patients (31.1%) had urinary testosterone excretion greater than 12 micrograms daily (up to 77 micrograms). The difference in percentage of high excretors was significant (p less than 0.02). Of the patients treated by ovariectomy, 27 had supranormal testosterone excretion preoperatively, and 16 of these (59.2%) had remissions; 66 had normal excretion preoperatively, and 21 of these (31.8%) had remissions. The difference was significant (p less than 0.02). Urinary testosterone excretion was restudied postoperatively in 42 of the 93 ovariectomized patients. Values were normal preoperatively in 31, and these were unchanged postoperatively. Values were supranormal preoperatively in 11; all of these fell significantly after ovariectomy, to normal in 8 cases. These findings appear to confirm the ovarian source of the excessive urinary testosterone. The following conclusions were drawn. There is a subgroup of premenopausal women with primary operable breast cancer who have supranormal urinary testosterone excretion; the incidence of this abnormality in women with recurrent metastatic disease after mastectomy is nearly twice as high. It can be calculated that the finding of supranormal urinary testosterone shortly after mastectomy represents virtually a 100% risk of recurrence, in contrast to a recurrence rate of about 38% in women with normal testosterone excretion. Patients with supranormal testosterone excretion prior to therapeutic ovariectomy have nearly twice as high a remission rate as do those with normal testosterone excretion.