Preoperative hypogonadism is not an independent predictor of high-risk disease in patients undergoing radical prostatectomy

Abstract

Background: A study was undertaken to assess the association between either preoperative serum total testosterone (TT) or hypogonadism (defined as TT <3 ng/mL) with high-risk prostate cancer (PCa) (defined as patients with pathological extracapsular extension [ECE], seminal vesicle invasion [SVI], or Gleason grades ≥4 + 3 [high-grade PCa]) at radical prostatectomy (RP).

Methods: A cohort of 673 consecutive Caucasian-European patients who underwent RP at a single institute was used. None of the patients had taken any hormonal neoadjuvant treatment or other hormonal preparations during the previous 12 months. Serum TT was measured the day before surgery (8-10 AM) in all cases. Logistic regression models tested the associations among predictors (eg, prostate-specific antigen, clinical stage, biopsy Gleason sum, body mass index, and TT) and ECE, SVI, and high-grade PCa.

Results: Median TT was 4.5 ng/mL (mean, 4.5; range, 0.02-13.6). Hypogonadism was found in 144 (21.4%) patients, and severe hypogonadism (defined as TT <1 ng/mL) was observed in 37 (5.5%) men. Extracapsular extension, SVI, and high-grade PCa were found in 96 (14.6%), 88 (13.1%), and 153 (22.7%) patients, respectively. Patients with high-risk PCa had median TT comparable to those with low-risk disease. At multivariate analysis, TT did not achieve independent predictor status for ECE, SVI, and high-grade PCa. Only circulating TT <1 ng/mL was an independent predictor of SVI (odds ratio, 3.11; P = .006).

Conclusions: In contrast with previous reports, preoperative circulating TT levels were not associated with high-risk PCa. Likewise, hypogonadism did not achieve independent predictor status for high-risk PCa.