Preoperative endogenous total testosterone predicts prostate cancer progression: results in 580 consecutive patients treated with robot assisted radical prostatectomy for clinically localized disease

• Published in: International urology and nephrology Vol. 55; no. 5; pp. 1139 - 1148
• Main Authors: Porcaro, Antonio Benito, Panunzio, Andrea, Serafin, Emanuele, Bianchi, Alberto, Gallina, Sebastian, Mazzucato, Giovanni, Vidiri, Stefano, D’Aietti, Damiano, Orlando, Rossella, Ditonno, Francesco, Montanaro, Francesca, Marafioti Patuzzo, Giulia, Bailelli, Alberto, Artoni, Francesco, Zecchini Antoniolli, Stefano, Rizzetto, Riccardo, Brunelli, Matteo, Siracusano, Salvatore, Cerruto, Maria Angela, Tafuri, Alessandro, Antonelli, Alessandro
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.05.2023; Springer Nature B.V
• Subjects: Biopsy; Cancer surgery; Disease Progression; Humans; Male; Medicine; Medicine & Public Health; Metastases; Neoplasm Recurrence, Local - epidemiology; Nephrology; Pathology; Prognosis; Prostate cancer; Prostate-Specific Antigen; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - pathology; Regression analysis; Risk groups; Robotic surgery; Robotics; Statistical analysis; Testosterone; Tumors; Urological surgery; Urology; Urology - Original Paper; Prostatectomy; Androgens; Prostate cancer; Disease progression
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-023-03563-8

Purpose To test the role of endogenous total testosterone (ETT) as a predictor of prostate cancer (PCa) progression in patients treated with robot assisted radical prostatectomy for clinically localized disease. Methods Between November 2014 and December 2019, 580 consecutive patients were evaluated. Preoperative ETT levels were classified as ≤ 350 ng/dL vs. > 350 ng/dL. The associations between ETT levels and the risk of PCa progression, defined as any event of biochemical recurrence and/or local recurrence and/or distant metastases, or other clinical and pathological factors were evaluated by regression analyses. Results Preoperative ETT levels resulted ≤ 350 ng/dL in 173 (29.8%) patients. Disease progression occurred in 101 (17.1%) cases. Progressing patients were more likely to present with PSA levels > 10 ng/mL, as well as with unfavorable tumor grade (ISUP 4–5) and stage (pT3b) at final pathology, but less likely to have ETT levels ≤ 350 ng/mL. On clinical multivariable Cox regression models, ETT ≤ 350 ng/mL exhibited a statistically significant protective effect on tumor progression (hazard ratio: 0.57, p  = 0.013). Subjects presenting with ETT levels ≤ 350 ng/mL were less likely to harbor ISUP 4–5 tumor grade either at biopsy (odds ratio [OR]: 0.46, p  = 0.028) or final pathology (OR: 0.45, p  = 0.032). Conclusions At PCa diagnosis, ETT, which associates with ISUP tumor grade, is an independent predictor of disease progression. Accordingly, as ETT decreases to levels ≤ 350 ng/dL, the risk of unfavorable tumor grade decreases, and a more favorable prognosis is expected. Preoperative ETT levels may allow further patient stratification along prognostic risk groups.