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. 2020 Jun 24:12:1756287220929481.
doi: 10.1177/1756287220929481. eCollection 2020 Jan-Dec.

Basal total testosterone serum levels predict biopsy and pathological ISUP grade group in a large cohort of Caucasian prostate cancer patients who underwent radical prostatectomy

Alessandro Tafuri  1 , Marco Sebben  1 , Riccardo Rizzetto  1 , Nelia Amigoni  1 , Aliasger Shakir  2 , Tania Processali  1 , Marco Pirozzi  1 , Alessandra Gozzo  1 , Katia Odorizzi  1 , Mario De Michele  1 , Sebastian Gallina  1 , Alberto Bianchi  1 , Paola Irene Ornaghi  1 , Matteo Brunelli  3 , Filippo Migliorini  1 , Maria Angela Cerruto  1 , Salvatore Siracusano  1 , Walter Artibani  1 , Alessandro Antonelli  1 , Antonio B Porcaro  4
Affiliations

Basal total testosterone serum levels predict biopsy and pathological ISUP grade group in a large cohort of Caucasian prostate cancer patients who underwent radical prostatectomy

Alessandro Tafuri et al. Ther Adv Urol. .

Abstract

Aims: The study aimed to evaluate associations of preoperative total testosterone (TT) with the risk of aggressive prostate cancer (PCA).

Materials & methods: From 2014 to 2018, basal TT levels were measured in 726 consecutive PCA patients. Patients were classified according to the International Society of Urologic Pathology (ISUP) system. Aggressive PCA was defined by the detection of ISUP > 2 in the surgical specimen. The logistic regression model evaluated the association of TT and other clinical factors with aggressive PCA.

Results: On univariate analysis, there was a significant association of basal TT with the risk of aggressive PCA as well as age, prostate-specific antigen (PSA), percentage of biopsy positive cores (BPC), tumor clinical stage (cT), and biopsy ISUP grade groups. On multivariate analysis, two models were considered. The first (model I) excluded biopsy ISUP grading groups and the second (model II) included biopsy ISUP grade groups. Multivariate model I, revealed TT as well as all other variables, was an independent predictor of the risk of aggressive disease [odds ratio (OR) = 1.585; 95% confidence interval (CI): 1.113-2.256; p = 0.011]. Elevated basal PSA greater than 20 µg/dl was associated with the risk of aggressive PCA. Multivariate model II revealed that basal TT levels maintain a positive association between aggressive PCA, whereas age, BPC, and clinical stage cT3 lost significance. In the final adjusted model, the level of risk of TT did not change from univariate analysis (OR = 1.525; 95% CI: 1.035-2.245; p = 0.011).

Conclusion: Elevated preoperative TT levels are associated with the risk of aggressive PCA in the surgical specimen. TT may identify patients who are at risk of aggressive PCA in the low and intermediate European Association of Urology (EAU) risk classes.

Keywords: ISUP grade groups; prostate biopsy; prostate cancer; prostate cancer grade; radical prostatectomy; testosterone serum level.

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Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
TT curve predicting the risk of aggressive PCA; as shown, there is an increasing risk of detecting aggressive PCA in the surgical specimen along increasing basal levels of TT. ISUP, International Society of Urologic Pathology; PCA, prostate cancer; TT, total testosterone.
Figure 2.
Figure 2.
Distribution of aggressive PCA along TT quartiles, percentages of aggressive disease are increasing along TT quartiles while those with non-aggressive disease are decreasing. PCA, prostate cancer; TT, total testosterone.
Figure 3.
Figure 3.
Median TT basal levels in EAU risk classes: median TT levels were significantly higher in aggressive disease along EAU classes as well as increasing for both aggressive and non-aggressive PCA along EAU risk classes. EAU, European Association of Urology; PCA, prostate cancer; TT, total testosterone.
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