Abstract
INTRODUCTION AND OBJECTIVES: Both low serum testosterone levels and overweight have been reported to associated with advanced prostate cancer (PC) stage and grade. Even though the biological process underlying these observations is not yet fully understood. Moreover, serum testosterone levels and body composition are also known to be related. The aim of this study was to prospectively evaluate whether low testosterone levels, or obesity, or both are directly associated with stage/grade in patients with clinically localized PC. METHODS: Pre-operative sex hormone levels (total (tT) and free testosterone (fT), sexual hormone-binding globulin (SHBG), body mass index (BMI), waist circumference (WC) were prospectively assessed in 776 consecutive European Caucasian men treated with radical prostatectomy from February 2011 to October 2014. The results were had been related to patient specific and clinicopathologic data. RESULTS: Patients with BMI 30 kg/m (n1⁄4146) and WC 110 cm (highest quartile; n1⁄4210) were shown to be significantly associated with pathological tumor grade (Gleason Score >7; p1⁄40.012 and p pT2; p1⁄40.02). Patients with BMI 30 kg/m vs. 7) or extraprostatic disease (>pT2) or lymph node metastases. On multivariable logistic regression analysis, both BMI 30 kg/m (relative risk 2.266; 95% CI 1.169 e 4.391; p1⁄40.015) and WC 110 cm (relative risk 2.539; 95% CI 1.618 e 5.511; p 7) and WC 110 cm was associated significantly with lymph node metastases (relative risk 2.536; 95% CI 1.338 e 4.805; p1⁄40.004) after accounting for tT and age. CONCLUSIONS: This is the first study showing that obesity but not low serum testosterone levels is significantly associated with high grade and metastatic disease in men diagnosed with clinically localized PC. Our findings suggest that low androgen levels at diagnosis, which used to be held responsible for the development of aggressive PC, is only an epiphenomenon of obesity rather than the cause of PC development and/or progression.
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