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Clinical implications of endogenous testosterone density on prostate cancer progression in patients with very favorable low and intermediate risk treated with radical prostatectomy

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Asian Journal of Andrology 2023年第5期25卷 556-563页

作者： Antonio Benito Porcaro Alessandro Tafuri Andrea Panunzio Clara Cerrato Alberto Bianchi sebastian gallina Stefano Vidiri Damiano D'Aietti Emanuele Serafin Giovanni Mazzucato Alessandro Princiotta Davide Brusa Matteo Brunelli Vincenzo Pagliarulo Maria Angela Cerruto AlessandroAntonelli Department of Urology University of VeronaIntegrated University Hospital of VeronaVerona 37126Italy Department of Urology Vito Fazzi HospitalLecce 73100Italy Department of Pathology University of VeronaIntegrated University Hospital of VeronaVerona 37126Italy

We tested the association between endogenous testosterone density(ETD;the ratio between endogenous testosterone[ET]and prostate volume)and prostate cancer(PCa)aggressiveness in very favorable low-and intermediate-risk PCa patients who underwent radical prostatectomy(RP).Only patients with prostate-specific antigen(PSA)within 10 ng ml^(-1),clinical stage T1c,and International Society of Urological Pathology(IsUP)grade group 1 or 2 were included.Preoperative ET levels up to 350 ng dl^(-1)were classified as abnormal.Tumor quantitation density factors were evaluated as the ratio between percentage of biopsy-positive cores and prostate volume(biopsy-positive cores density,BPCD)and the ratio between percentage of cancer invasion at final pathology and prostate weight(tumor load density,TLD).Disease upgrading was coded as ISUP grade group>2,and progression as recurrence(biochemical and/or local and/or distant).Risk associations were evaluated by multivariable Cox and logistic regression models.Of 320 patients,151(47.2%)had intermediate-risk PCa.ET(median:402.3 ng dl^(-1))resulted abnormal in 111(34.7%)cases(median ETD:9.8 ng dl^(-1)ml^(-1)).Upgrading and progression occurred in 109(34.1%)and 32(10.6%)cases,respectively.Progression was predicted by ISUP grade group 2(hazard ratio[HR]:2.290;P=0.029)and upgrading(HR:3.098;P=0.003),which was associated with ISUP grade group 2(odds ratio[OR]:1.785;P=0.017)and TLD above the median(OR:2.261;P=0.001).After adjustment for PSAdensity and bodymass index(BMI),ETDabovethemedianwas positivelyassociatedwithBPCD(OR:3.404;P<0.001)and TLD(OR:5.238;P<0.001).Notably,subjects with abnormal ET were more likely to have higher BPCD(OR:5.566;P=0.002),as well as TLD(OR:14.998;P=0.016).Independently by routinely evaluated factors,as ETD increased,BPCD and TLD increased,but increments were higher for abnormal ET levels.In very favorable cohorts,ETD may further stratify the risk of aggressive PCa.

关键词： endogenous testosterone density prostate cancer radical prostatectomy tumor progression

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