Editor's Commentary - Circulating estradiol, but not testosterone, is a significant predictor of high-grade prostate cancer in patients undergoing radical prostatectomy

BERKELEY, CA (UroToday.com) - Dr. Andrea Salonia and colleagues studied the association between preoperative estrogen levels and high-grade prostate cancer (HGPC) and reported their findings in the online edition of Cancer.

They studied 710 patients with prostate cancer (CaP) who underwent radical prostatectomy (RP) between 2007 and 2009. Blood was drawn prior to RP for measurement of total serum testosterone, estrogen, and sex hormone binding globulin. The hormone levels were correlated with the pathology from RP. Several models were fitted using different variables.

HGPC was found at RP in 156 patients. HGPC correlated with advanced pathologic stage compared with men who did not have HGPC. There were no significant differences regarding age, BMI, serum total testosterone, sex hormone binding globulin and continuously coded estrogen between groups. Among the 156 men with HGPC, 29 (18.6%) had estrogen levels >50pg/mL and 127 men (81.4%) had levels <50pg/mL. Estrogen levels <50pg/mL had significantly lower total testosterone and sex hormone binding globulin levels compared with men who had estrogen levels >50pg/mL. Estrogen levels >50pg/mL also correlated with higher rat of biopsy Gleason grade ≥4+3 and advanced pathological stage. In univariate analysis, predictors of HGPC included PSA, BMI, cT3 tumors, and biopsy Gleason sum ≥7. Both continuously coded estrogen and categorized estrogen achieved independent predictor status for HGPC. Age, total testosterone and sex hormone binding globulin did not. In multivariate analysis, age, BMI, PSA, total testosterone, sex hormone binding globulin, clinical stage and biopsy Gleason score and 80.1% accuracy. However, continuously coded estrogen and categorized estrogen did not statistically significantly add to the predictive accuracy of the model. Thus, men with estrogen levels >50pg/mL had a 3.24 fold increase in risk of HGPC.

Salonia A, Gallina A, Briganti A, Suardi N, Capitanio U, Abdollah F, Bertini R, Freschi M, Rigatti P, Montorsi F


Cancer. 2011 Apr 14. Epub ahead of print.

PubMed Abstract
PMID: 21495024

UroToday.com Prostate Cancer Section

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