Preoperative testosterone level predicts unfavourable disease at radical prostatectomy.

[pjoshea13]

New Italian study below [1].

"In this study, we evaluated whether serum testosterone levels may have a role in predicting unfavorable disease (UD) and biochemical recurrence (BCR) in patients with clinically localized (≤ cT2c) ISUP grade group 1 PCa at biopsy."

"BCR-free survival was significantly decreased in patients with low levels of testosterone"

This study adds to a significant number of studies that have associated low testosterone with a poorer prognosis.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/326...

World J Urol

. 2020 Jul 18. doi: 10.1007/s00345-020-03368-9. Online ahead of print.

Circulating preoperative testosterone level predicts unfavourable disease at radical prostatectomy in men with International Society of Urological Pathology Grade Group 1 prostate cancer diagnosed with systematic biopsies

Matteo Ferro 1 , Giuseppe Lucarelli 2 , Ottavio de Cobelli 3 4 , Mihai Dorin Vartolomei 5 6 , Rocco Damiano 7 , Francesco Cantiello 7 , Fabio Crocerossa 7 , Sisto Perdonà 8 , Paola Del Prete 9 , Giovanni Cordima 3 , Gennaro Musi 3 , Francesco Del Giudice 10 , Gian Maria Busetto 10 , Benjamin I Chung 11 , Angelo Porreca 12 , Pasquale Ditonno 13 14 , Michele Battaglia 13 , Daniela Terracciano 15

Affiliations collapse

Affiliations

1 Division of Urology, European Institute of Oncology (IEO), IRCCS, via Ripamonti 435, 20141, Milan, Italy. [e-mail].

2 Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy. [e-mail].

3 Division of Urology, European Institute of Oncology (IEO), IRCCS, via Ripamonti 435, 20141, Milan, Italy.

4 Department of Oncology and Hematology-Oncology, Università Degli Studi Di Milano, Milan, Italy.

5 Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.

6 Department of Cell and Molecular Biology, University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania.

7 Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.

8 Division of Urology, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Naples, Italy.

9 Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Naples, Italy.

10 Department of Urology, Sapienza Rome University, Rome, Italy.

11 Department of Urology, Stanford University Medical Center, Palo Alto, CA, USA.

12 Department of Urology, Policlinico Abano Terme, Abano Terme, Italy.

13 Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Piazza G. Cesare 11, 70124, Bari, Italy.

14 National Cancer Institute "Giovanni Paolo II", Bari, Italy.

15 Department of Translational Medical Sciences, University of Naples "Federico II", 8031, Naples, Italy.

PMID: 32683462 DOI: 10.1007/s00345-020-03368-9

Abstract

Purpose: The association between circulating total testosterone (T) levels and clinically significant PCa is still a matter of debate. In this study, we evaluated whether serum testosterone levels may have a role in predicting unfavorable disease (UD) and biochemical recurrence (BCR) in patients with clinically localized (≤ cT2c) ISUP grade group 1 PCa at biopsy.

Methods: 408 patients with ISUP grade group 1 prostate cancer, undergone to radical prostatectomy and T measurement were included. The outcome of interest was the presence of unfavourable disease (UD) defined as ISUP grade group [Formula: see text] 3 and/or pT [Formula: see text] 3a.

Results: Statistically significant differences resulted between serum testosterone values and ISUP grade groups (P < 0.0001). Significant correlation was found analyzing testosterone values versus age (P < 0.0001), and versus PSA (P = 0.008). BCR-free survival was significantly decreased in patients with low levels of testosterone (P = 0.005). These findings were confirmed also in the ISUP 1-2 subgroups (P = 0.01). ROC curve analysis showed that T outperformed PSA in predicting UD (AUC 0.718 vs AUC 0.525; P < 0.001) and was and independent risk factor for BCR.

Conclusion: Our findings suggested that circulating total T was a significant predictor of UD at RP in patients with preoperative low- to intermediate-risk diseases, confirming the potential role of circulating androgens in preoperative risk assessment of PCa patients.

Keywords: ISUP; Prostate cancer; Testosterone; Unfavourable disease; Upgrading; Upstaging.

[pwallace]

can confirm this was our case! my husband was only 41 & his testosterone level was 178 at the time of diagnosis.

[dublin1717]

I’m so

The higher the testosterone level in a man at RP the more likely of recurrence.

In the above study.

I’m new to this but is that right!

[FRTHBST in reply to dublin1717]

It looks like what the study says is that Higher Levels of testosterone point to a better outcome, less chance of biochemical recurrence after RP. Interesting.

[pjoshea13 in reply to dublin1717]

No - the reverse.

At least up to the point of diagnosis, more testosterone is better. It appears to be protective.

I say "more" rather than give a target, since men lose 1-2% every year, starting at about age 32. When we reach the PCa years we are way down. Any extra may be beneficial.

Unfortunately, many younger men have low T due to chronic infections that Cipro doesn't reach. Seems to be much more common these days.

-Patrick

[pjoshea13]

Nala,

I remember.

But I also recall a VA study where hypogonadal veterans were offered TRT. Many accepted & many declined (so there might be enrollment bias), but those that accepted had less PCa later.

I posted that study but can't put my hands on it right now.

TRT can also improve mortality:

pubmed.ncbi.nlm.nih.gov/224...

"The mortality in testosterone-treated men was 10.3% compared with 20.7% in untreated men ... with a mortality rate of 3.4 deaths per 100 person-years for testosterone-treated men and 5.7 deaths per 100 person-years in men not treated with testosterone."

-Patrick