Abstract
ObjectivesTo evaluate preoperative endogenous testosterone (ET) density (ETD), defined as the ratio of ET on prostate volume, and tumor upgrading risk in low-risk prostate cancer (PCa).Materials and methodsFrom November 2014 to December 2019, 172 low-risk patients had ET (nmol/L) measured. ETD, prostate-specific antigen density (PSAD) and the ratio of percentage of biopsy positive cores (BPC) to prostate volume (PV), defined as BPC density (BPCD), were evaluated. Associations with tumor upgrading in the surgical specimen were assessed by statistical methods.ResultsOverall, 121 patients (70.3%) had tumor upgrading, which was predicted by BPCD (odds ratio, OR = 4.640; 95% CI 1.903–11.316; p = 0.001; overall accuracy: 70.3%). On multivariate analysis, tumor upgrading and clinical density factors related to each other for BPCD being predicted by ETD (regression coefficient, b = 0.032; 95% CI 0.021–0.043; p < 0.0001), PSAD (b = 1.962; 95% CI 1.067–2.586; p < 0.0001) and tumor upgrading (b = 0.259; 95% CI 0.112–0.406; p = 0.001). According to the model, as BPCD increased, ETD and PSAD increased, but the increase was higher for upgraded cases who showed either higher tumor load but significantly lower mean levels of either ET or PSA.ConclusionsAs ETD increased, higher tumor loads were assessed; however, in upgraded patients, lower ET was also detected. ETD might stratify low-risk disease for tumor upgrading features.
Highlights
Prostate cancer (PCa) is a health priority for being the second most commonly cancer detected in the aging male [1, 2]
We have shown that Endogenous testosterone (ET) density (ETD) together with Prostate-specific antigen (PSA) density (PSAD) associated with the risk of high tumor load in the surgical specimen of low-risk PCa patients [9]
We adjusted biopsy positive cores (BPC), PSA and ET as densities related to prostate volume (PV); as such BPC density (BPCD, %/mL); PSAD and ETD [nmol/(L mL)] were calculated as the ratio of BPC, PSA and ET to PV, respectively
Summary
Prostate cancer (PCa) is a health priority for being the second most commonly cancer detected in the aging male [1, 2]. The low-risk category is a heterogenous set of patients in whom early detection may be associated with overdiagnosis and, as such, overtreatment [1, 2]. Pelvic lymph node dissection (PLND) is performed when the risk of cancer invasion varies from 2% to more than 5%, according to international guidelines [1, 2]. Reclassification and/or biochemical persistence as well as progression may occur in the low-risk category for upgrading and upstaging issues; side effects related to active treatments are drawbacks for indolent disease [1, 2]. More clinical parameters are needed to stratify low-risk patients according to cancer aggressive features; as a result, appropriate managements may be decided to improve quality of life features [1, 2]
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