Abstract
ObjectiveTo test the hypothesis that endogenous testosterone (ET) density could be associated with tumor load (TL) in patients with intermediate risk (IR) prostate cancer (PCa).Materials and methodsEndogenous testosterone density (ETD, ratio between ET and prostate volume [PV]), biopsy positive cores density (BPCD, the ratio between the number of positive cores and PV) and prostate-specific antigen density (PSAD, ratio between total PSA and PV) were retrospectively evaluated on a prospectively collected data on 430 patients with IR PCa submitted to radical prostatectomy (RP). Tumor load (TL) was measured as the percentage of prostatic volume occupied by cancer at final pathology. Unfavorable disease (UD) was defined as tumor upgrading (ISUP grading group 4, 5) and/or upstaging (pT3a or 3b) in prostate specimens. Associations were assessed by the logistic regression and linear regression models.ResultsOverall, UD, which was detected in 122 out of 430 IR patients (28.4%), was predicted by BPCD (odd ratio, OR = 1.356; 95% CI 1.048–1.754; p = 0.020) with a sensitivity 98.4% and overall accuracy 71.9%. On multivariate analysis, BPCD was independently predicted by PSAD (regression coefficient, b = 1.549; 95% CI 0.936–2.162; p < 0.0001), ETD (b = 0.032; 95% CI 0.023–0.040; p < 0.0001) and TL (b = 0.009; 95% CI 0.005–0.014; p < 0.0001). As BPCD increased, ETD and ET levels increased accordingly, but patients with BPCD > 1.0%/mL had significantly lower ET levels.ConclusionsAs ETD increased, BPCD and TL increased, accordingly; furthermore, patients with lower ET levels were more likely to have occult UD. The influence of tumor load, and unfavorable disease on ET and ETD needs to be addressed by further studies.
Highlights
In the aging male, prostate cancer (PCa) is the second most diagnosed tumor, which has a prevalence that increases along age groups from less than 5% by age 30 to 59% by age 80 [1]
Several authors investigated whether such events could be predicted, finding that prostate-specific antigen (PSA), PSA density (PSAD), percentage of biopsy positive cores (BPC) and tumor grade classification according to the International Society of Urologic Pathology (ISUP) are predictors of unfavorable disease (UD), which includes tumor upgrading and/or upstaging as well as high tumor load, at surgical pathology [2, 4, 5]
In lowrisk PCa, we have recently shown that endogenous testosterone (ET) density (ETD), defined as the ratio of ET and prostate volume (PV), was an independent predictor of the risk of high tumor load (TL), which associated with unfavorable disease in the surgical specimen [8]
Summary
Prostate cancer (PCa) is the second most diagnosed tumor, which has a prevalence that increases along age groups from less than 5% by age 30 to 59% by age 80 [1]. The risk of developing PCa has been related to genetic, physical (obesity, metabolic syndrome, hypogonadism), dietary and environmental factors, as well [2]. Early PCa occurs frequently while investigating on associated obstructive disorders or on opportunistic screening. According to European Association of Urology (EAU) guidelines, several risk categories can be identified as related to the risk of developing metastases [2]. Several authors investigated whether such events could be predicted, finding that prostate-specific antigen (PSA), PSA density (PSAD), percentage of biopsy positive cores (BPC) and tumor grade classification according to the International Society of Urologic Pathology (ISUP) are predictors of unfavorable disease (UD), which includes tumor upgrading and/or upstaging as well as high tumor load, at surgical pathology [2, 4, 5]. Further efforts in identifying reliable predictors of UD are needed
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