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.
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.
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).
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.
International urology and nephrology. 2023 Mar 21 [Epub ahead of print]
Antonio Benito Porcaro, Andrea Panunzio, Emanuele Serafin, Alberto Bianchi, Sebastian Gallina, Giovanni Mazzucato, Stefano Vidiri, Damiano D'Aietti, Rossella Orlando, Francesco Ditonno, Francesca Montanaro, Giulia Marafioti Patuzzo, Alberto Bailelli, Francesco Artoni, Stefano Zecchini Antoniolli, Riccardo Rizzetto, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto, Alessandro Tafuri, Alessandro Antonelli
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Di Verona, Piazzale Stefani 1, 37126, Verona, Italy. ., Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Di Verona, Piazzale Stefani 1, 37126, Verona, Italy., Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy., Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy., Department of Urology, Vito Fazzi Hospital, Lecce, Italy.