High serum testosterone is associated with poor pathological outcomes in patients with prostate cancer in Japanese populations
Horiguchi, Y1; Tsukuda, F1; Sakamoto, N1; Koga, S1
1: Edogawa Hospital, Japan
Objectives: Recent investigations revealed a close relationship of late-onset hypogonadism and prostate cancer, however, several controversial results are reported on the correlations between serum testosterone levels and aggressiveness of prostate cancer. In this study, we investigated preoperative serum total testosterone level (TT) and incidence and pathological outcomes in patients with prostate needle biopsy.
Methods: From July 2015 to May 2017, 368 Japanese men with elevated PSA were undergone prostate needle biopsy in our hospital. Preoperative TTs early in the morning, body mass index (BMI), serum PSA levels, total prostate volume and pathological outcomes of biopsy and succeeding prostatectomy were statistically analyzed with SPSS software.
Results: Of consecutive 368 Japanese men with prostate biopsy, 3 patients with non-prostate cancer pathologies, 1 patient with already initiated endocrine therapy before biopsy were excluded and remaining 364 patients were evaluated in this study. The median age and TT were 70.0 years (range: 40-90 years) and 4.45 ng/mL (0.73-12.40 ng/mL), respectively. The median PSA level and prostate volume were 8.12 ng/mL (2.53-460.72 ng/mL) and 36.8 cc (13.1-143.4 cc), respectively. PSA levels of 13 patients were over 100 ng/mL. As a whole, TTs only showed a significant negative correlation with BMI. Then, depending on TT, the patients were divided into 3 groups; Lo (<2.00 ng/mL), Mid (2.00≤, <8.00 ng/mL) and Hi (≤8.00 ng/mL). As biopsy results, 195 patients (53.6%) were diagnosed as prostate cancer. These positive biopsy results were obtained in 50.0%, 54.1% and 55.0% of Lo, Mid, and Hi group, respectively. Hi group resulted in significantly higher percentage of positive cores of biopsy than Lo (60.4% vs 28.0%, p=0.007) and Mid (60.4% vs 37.8%, p=0.008) group. Moreover, Hi group consisted of significantly higher Gleason score than Lo (7.9 vs 7.0, p=0.020) as well as Mid (7.9 vs 7.3, p=0.025) group. In 77 cases with later undergone radical prostatectomy, pT stage was significantly worse in Hi group than Lo group (pT3: 60% vs 0%, p=0.007).
Conclusions: It was confirmed that preoperative TT in prostate cancer patient is significantly related to the pathological results of prostate biopsy. Our results showed that high, but not low, TT is associated with higher positive pathological results with higher Gleason score and worse outcomes of pT stage in succeeding prostatectomy. Thus, TT might be a good predictor for aggressiveness of prostate cancer. Combined use of PSA and TT as a marker at the time of prostate biopsy should be further evaluated.
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