Abstract
PurposeThe association between circulating total testosterone (T) levels and clinically significant PCa is still a matter of debate. In this study, we evaluated whether serum testosterone levels may have a role in predicting unfavorable disease (UD) and biochemical recurrence (BCR) in patients with clinically localized (≤ cT2c) ISUP grade group 1 PCa at biopsy.Methods408 patients with ISUP grade group 1 prostate cancer, undergone to radical prostatectomy and T measurement were included. The outcome of interest was the presence of unfavourable disease (UD) defined as ISUP grade group ge 3 and/or pT ge 3a.ResultsStatistically significant differences resulted between serum testosterone values and ISUP grade groups (P < 0.0001). Significant correlation was found analyzing testosterone values versus age (P < 0.0001), and versus PSA (P = 0.008). BCR-free survival was significantly decreased in patients with low levels of testosterone (P = 0.005). These findings were confirmed also in the ISUP 1–2 subgroups (P = 0.01). ROC curve analysis showed that T outperformed PSA in predicting UD (AUC 0.718 vs AUC 0.525; P < 0.001) and was and independent risk factor for BCR.ConclusionOur findings suggested that circulating total T was a significant predictor of UD at RP in patients with preoperative low- to intermediate-risk diseases, confirming the potential role of circulating androgens in preoperative risk assessment of PCa patients.
Highlights
Androgens have long been recognized as “fuel” for the growth of prostate cancer (PCa) [1]
We evaluated whether serum testosterone levels may have a role in predicting unfavourable disease (UD) and biochemical recurrence (BCR) in patients with clinically localized (≤ cT2c) International Society of Urological Pathology (ISUP) grade group 1 PCa at biopsy
Significant differences resulted between serum testosterone values and ISUP grade groups (P < 0.0001; Spearman correlation: rs = − 0.366, P < 0.0001) (Fig. 1)
Summary
Androgens have long been recognized as “fuel” for the growth of prostate cancer (PCa) [1]. In vitro data showed that androgens caused growth of well-differentiated PCa cell. Matteo Ferro and Giuseppe Lucarelli contributed to this work. Extended author information available on the last page of the article lines [2], and in vivo results indicated that androgens promote prostate tumor xenograft progression [3]. Pre-operative testosterone levels association with PCa outcome is still controversial [4]. Some studies showed a significant decrease in PCa risk in men with increasing total testosterone [5]. Other authors demonstrated that high SHBG (sex-hormone binding globulin) and lower bioactive testosterone is associated with a moderate decrease in PCa risk [6]
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