Skip to main content
SpringerLink
Log in

Preoperative endogenous total testosterone predicts prostate cancer progression: results in 580 consecutive patients treated with robot assisted radical prostatectomy for clinically localized disease

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All data generated or analysed during this study are included in this article. Further enquires can be directed to the corresponding author.

References

  1. EAU Prostate Cancer Guidelines 2022, http://www.uroweb.org, Accessed July 22nd, 2022

  2. National Comprehensive Cancer Network, Prostate Cancer (version 4.2022), http://www.nccn.org, Accessed July 22nd, 2022

  3. Wallis CJD, Zhao Z, Huang L-C et al (2022) Association of treatment modality, functional outcomes, and baseline characteristics with treatment-related regret among men with localized prostate cancer. JAMA Oncol 8:50–59. https://doi.org/10.1001/jamaoncol.2021.5160

    Article  PubMed  Google Scholar 

  4. Cacciamani GE, Bassi S, Sebben M et al (2020) Consulting “Dr. Google” for prostate cancer treatment options: a contemporary worldwide trend analysis. Eur Urol Oncol 3:481–488. https://doi.org/10.1016/j.euo.2019.07.002

    Article  PubMed  Google Scholar 

  5. Porcaro AB, Amigoni N, Tafuri A et al (2021) Endogenous testosterone as a predictor of prostate growing disorders in the aging male. Int Urol Nephrol 53:843–854. https://doi.org/10.1007/s11255-020-02747-w

    Article  CAS  PubMed  Google Scholar 

  6. Porcaro AB, Siracusano S, Amigoni N et al (2021) The influence of endogenous testosterone on incidental prostate cancer after transurethral prostate resection. Urol Int 105:826–834. https://doi.org/10.1159/000514391

    Article  CAS  PubMed  Google Scholar 

  7. Tafuri A, Sebben M, Pirozzi M et al (2020) Association between basal total testosterone levels and prostate cancer D’Amico risk classes. Urol Int 104:716–723. https://doi.org/10.1159/000506525

    Article  CAS  PubMed  Google Scholar 

  8. Tafuri A, Sebben M, Rizzetto R et al (2020) Basal total testosterone serum levels predict biopsy and pathological ISUP grade group in a large cohort of Caucasian prostate cancer patients who underwent radical prostatectomy. Ther Adv Urol 12:1756287220929481. https://doi.org/10.1177/1756287220929481

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tafuri A, Sebben M, Shakir A et al (2020) Endogenous testosterone mirrors prostate cancer aggressiveness: correlation between basal testosterone serum levels and prostate cancer European Urology Association clinical risk classes in a large cohort of Caucasian patients. Int Urol Nephrol 52:1261–1269. https://doi.org/10.1007/s11255-020-02398-x

    Article  CAS  PubMed  Google Scholar 

  10. Porcaro AB, Cerrato C, Tafuri A et al (2021) Low endogenous testosterone levels are associated with the extend of lymphnodal invasion at radical prostatectomy and extended pelvic lymph node dissection. Int Urol Nephrol 53:2027–2039. https://doi.org/10.1007/s11255-021-02938-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Porcaro AB, Tafuri A, Sebben M et al (2019) Positive association between basal total testosterone circulating levels and tumor grade groups at the time of diagnosis of prostate cancer. Urol Int 103:400–407. https://doi.org/10.1159/000500960

    Article  CAS  PubMed  Google Scholar 

  12. Porcaro AB, Panunzio A, Bianchi A et al (2023) Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy. Ther Adv Urol 15:17562872231154150. https://doi.org/10.1177/17562872231154150

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wang C, Nieschlag E, Swerdloff R et al (2009) Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. J Androl 30:1–9. https://doi.org/10.2164/jandrol.108.006486

    Article  PubMed  Google Scholar 

  14. Dripps RD, Lamont A, Eckenoff JE (1961) The role of anesthesia in surgical mortality. JAMA 178:261–266. https://doi.org/10.1001/jama.1961.03040420001001

    Article  CAS  PubMed  Google Scholar 

  15. Tafuri A, Sebben M, Pirozzi M et al (2020) Predictive factors of the risk of long-term hospital readmission after primary prostate surgery at a single tertiary referral center: preliminary report. Urol Int 104:465–475. https://doi.org/10.1159/000505409

    Article  PubMed  Google Scholar 

  16. van Kwast TH, Amin MB, Billis A et al (2011) International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume. Mod Pathol 24:16–25. https://doi.org/10.1038/modpathol.2010.156

    Article  PubMed  Google Scholar 

  17. Klap J, Schmid M, Loughlin KR (2015) The relationship between total testosterone levels and prostate cancer: a review of the continuing controversy. J Urol 193:403–413. https://doi.org/10.1016/j.juro.2014.07.123

    Article  CAS  PubMed  Google Scholar 

  18. Lopez DS, Advani S, Tsilidis KK et al (2017) Endogenous and exogenous testosterone and prostate cancer: decreased-, increased- or null-risk. Transl Androl Urol. 6:566–579. https://doi.org/10.21037/tau.2017.05.35

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lane BR, Stephenson AJ, Magi-Galluzzi C et al (2008) Low testosterone and risk of biochemical recurrence and poorly differentiated prostate cancer at radical prostatectomy. Urology 72:1240–1245. https://doi.org/10.1016/j.urology.2008.06.001

    Article  PubMed  Google Scholar 

  20. Yamamoto S, Yonese J, Kawakami S et al (2007) Preoperative serum testosterone level as an independent predictor of treatment failure following radical prostatectomy. Eur Urol 52:696–701. https://doi.org/10.1016/j.eururo.2007.03.052

    Article  CAS  PubMed  Google Scholar 

  21. Izumi K, Shigehara K, Nohara T et al (2017) Both high and low serum total testosterone levels indicate poor prognosis in patients with prostate cancer. Anticancer Res. https://doi.org/10.21873/anticanres.11988

    Article  PubMed  Google Scholar 

  22. Tu H, Gu J, Meng QH et al (2017) Low serum testosterone is associated with tumor aggressiveness and poor prognosis in prostate cancer. Oncol Lett 13:1949–1957. https://doi.org/10.3892/ol.2017.5616

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Tafuri A, Porcaro AB, Shakir A et al (2021) Serum testosterone and obesity in prostate cancer biology: a call for health promotion in the ageing male. Aging Clin Exp Res 33:1399–1401. https://doi.org/10.1007/s40520-020-01625-w

    Article  PubMed  Google Scholar 

  24. Morgentaler A, Traish AM (2009) Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol 55:310–321. https://doi.org/10.1016/j.eururo.2008.09.024

    Article  PubMed  Google Scholar 

  25. Oderda M, Diamand R, Albisinni S et al (2021) Indications for and complications of pelvic lymph node dissection in prostate cancer: accuracy of available nomograms for the prediction of lymph node invasion. BJU Int 127:318–325. https://doi.org/10.1111/bju.15220

    Article  PubMed  Google Scholar 

  26. Antonelli A, VismaraFugini A, Tardanico R et al (2014) The percentage of core involved by cancer is the best predictor of insignificant prostate cancer, according to an updated definition (tumor volume up to 2.5 cm3): analysis of a cohort of 210 consecutive patients with low-risk Disease. Urology 83:28–32. https://doi.org/10.1016/j.urology.2013.07.056

    Article  PubMed  Google Scholar 

  27. Brambilla DJ, Matsumoto AM, Araujo AB, McKinlay JB (2009) The effect of diurnal variation on clinical measurement of serum testosterone and other sex hormone levels in men. J Clin Endocrinol Metab 94:907–913. https://doi.org/10.1210/jc.2008-1902

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors declare they did not receive any financial support.

Author information

Author notes

  1. Antonio Benito Porcaro and Andrea Panunzio have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Di Verona, Piazzale Stefani 1, 37126, Verona, Italy

    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, Maria Angela Cerruto & Alessandro Antonelli

  2. Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy

    Matteo Brunelli

  3. Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

    Salvatore Siracusano

  4. Department of Urology, Vito Fazzi Hospital, Lecce, Italy

    Alessandro Tafuri

Authors
  1. Antonio Benito Porcaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Panunzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emanuele Serafin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alberto Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sebastian Gallina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giovanni Mazzucato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefano Vidiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Damiano D’Aietti
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rossella Orlando
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Francesco Ditonno
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Francesca Montanaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Giulia Marafioti Patuzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Alberto Bailelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Francesco Artoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Stefano Zecchini Antoniolli
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Riccardo Rizzetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Matteo Brunelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Salvatore Siracusano
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Maria Angela Cerruto
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Alessandro Tafuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Alessandro Antonelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ABP: project development, data analysis and interpretation, manuscript writing. AP: data collection, manuscript writing. ES, AB, SG, GM, SV, DD, RO, FD, FM, GMP, AB, and FA, data collection. SZA, RR, MB. SS, MAC, AT: supervision and critical revision for important intellectual content. AA: project development, data analysis and interpretation, supervision and critical revision for important intellectual content.

Corresponding author

Correspondence to Antonio Benito Porcaro.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by our Institutional Review Board. Data were collected prospectively but evaluated retrospectively; as such, Ethical Committee Approval was not required.

Informed consent

Informed consent was obtained from all individual participants included in the study generated or analyzed during this study are included in this article. Further enquires can be directed to the corresponding author.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Porcaro, A.B., Panunzio, A., Serafin, E. et al. Preoperative endogenous total testosterone predicts prostate cancer progression: results in 580 consecutive patients treated with robot assisted radical prostatectomy for clinically localized disease. Int Urol Nephrol 55, 1139–1148 (2023). https://doi.org/10.1007/s11255-023-03563-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-023-03563-8

Keywords

Search

Navigation