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

• Published in: International urology and nephrology Vol. 54; no. 3; pp. 541 - 550
• Main Authors: Porcaro, Antonio Benito, Tafuri, Alessandro, Panunzio, Andrea, Mazzucato, Giovanni, Cerrato, Clara, Gallina, Sebastian, Bianchi, Alberto, Rizzetto, Riccardo, Amigoni, Nelia, Serafin, Emanuele, Cianflone, Francesco, Orlando, Rossella, Gentile, Ilaria, Migliorini, Filippo, Zecchini Antoniolli, Stefano, Di Filippo, Giacomo, Brunelli, Matteo, Pagliarulo, Vincenzo, Cerruto, Maria Angela, Antonelli, Alessandro
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.03.2022; Springer Nature B.V
• Subjects: Aged; Biopsy; Cancer surgery; Humans; Lymph Node Excision; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Nephrology; Organ Size; Patients; Pelvis; Predictive Value of Tests; Prostate - pathology; Prostate cancer; Prostatectomy; Prostatectomy - methods; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; Retrospective Studies; Risk Assessment; Testosterone; Testosterone - blood; Tumors; Urological surgery; Urology; Urology - Original Paper; Endogenous testosterone density; Prostate specific antigen; Percentage of biopsy positive cores density; Radical prostatectomy; Pelvic lymph node invasion; Prostate volume; Endogenous testosterone; Prostate cancer; Prostate specific antigen density; High risk prostate cancer; Extended pelvic lymph node dissection; Tumor load density
• ISSN: 0301-1623; 1573-2584; 1573-2584
• DOI: 10.1007/s11255-022-03103-w

Objective To 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 methods ETD 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. Results Overall, 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). Conclusions As 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.