Endogenous testosterone density is an independent predictor of pelvic lymph node invasion in high-risk prostate cancer: results in 201 consecutive patients treated with radical prostatectomy and extended pelvic lymph node dissection

Giacomo Di Filippo,Giovanni Mazzucato,Vincenzo Pagliarulo,Stefano Zecchini Antoniolli,Francesco Cianflone,Antonio Benito Porcaro,Matteo Brunelli,Filippo Migliorini,Maria Angela Cerruto,Alessandro Tafuri,Nelia Amigoni,Andrea Panunzio,Emanuele Serafin,Alessandro Antonelli,Riccardo Rizzetto,Alberto Bianchi,Ilaria Gentile,Sebastian Gallina,Rossella Orlando,Clara Cerrato

doi:10.1007/s11255-022-03103-w

Abstract

ObjectiveTo evaluate the influence of endogenous testosterone density (ETD) on pelvic lymph node invasion (PLNI) in high risk (HR) prostate cancer (PCa) treated with radical prostatectomy (RP) and staged with extended pelvic lymph node dissection (ePLND).Materials and methodsETD was evaluated as the ratio of endogenous testosterone (ET) on prostate volume (PV). HR-PCa was assessed according to the European Association of Urology (EAU) system. The association of ETD and other routinely clinical factors (BPC: percentage of biopsy positive cores; PSA: prostate specific antigen; ISUP: tumor grade system according to the International Society of Urologic Pathology; cT: tumor clinical stage) with the risk of PLNI was assessed by the logistic regression model.ResultsOverall, 201 out of 805 patients (24.9%) were classified HR and PLNI occurred in 42 subjects (20.9%). On multivariate analysis, PLNI was independently predicted by BPC (OR 1.020; 95% CI 1.006–1.035; p = 0.019), ISUP > 3 (OR 2.621; 95% CI 1.170–5.869; p = 0.019) and ETD (OR 0.932; 95% CI 0.870–0.999; p = 0.045). After categorizing continuous clinical predictors, the risk of PLNI was independently increased by ETD up to the median (OR 2.379; 95% CI 1.134–4.991; p = 0.022), BPC > 50% (OR 3.125; 95% CI 1.520–6.425; p = 0.002) as well as by ISUP > 3 (OR 2.219; 95% CI 1.031–4.776; p = 0.042).ConclusionsAs ETD measurements decreased, patients were more likely to have PLNI. In HR disease with PLNI, the influence of PCa on ETD should be addressed by higher level studies.

Highlights

Prostate cancer (PCa) is the second most diagnosed tumor in the aging male and its management has become a pivotal health problem in developing countries [1, 2]
In low risk PCa, we have recently shown that Endogenous testosterone (ET) density (ETD), defined as the ratio of ET on prostate volume (PV), was an independent predictor of the risk of high tumor load (TL), which associated with unfavorable disease in the surgical specimen [7]
Associations of ETD and other clinical/pathological factors with the risk of pelvic lymph node invasion (PLNI) were assessed by the logistic regression model; the discriminant power of significant continuous predictors were assessed by receiver operating characteristic (ROC) curve analysis with relative area under the curve (AUC)

Summary

Introduction

Prostate cancer (PCa) is the second most diagnosed tumor in the aging male and its management has become a pivotal health problem in developing countries [1, 2]. The high risk (HR) class is the most controversial for both classification among international societies and treatment which may include, for localized disease, radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND), radiotherapy (RT) and androgen suppression therapy and or a combination of multimodality treatments [1, 2]. An accurate anatomical staging using extended template is a critical issue for the high risk of pelvic lymph node invasion (PLNI) [1, 2]. In low risk PCa, we have recently shown that ET density (ETD), defined as the ratio of ET on prostate volume (PV), was an independent predictor of the risk of high tumor load (TL), which associated with unfavorable disease in the surgical specimen [7].

Methods

Results

Conclusion