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Total testosterone density predicts high tumor load and disease reclassification of prostate cancer: results in 144 low-risk patients who underwent radical prostatectomy

  • Urology - Original Paper
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Abstract

Objectives

The aim of this study is to evaluate the association between total testosterone density (TTD), defined as the ratio of serum TT to prostate volume (PV), and high tumor load (HTL) in low-risk prostate cancer (PCA) patients who underwent radical prostatectomy.

Materials and methods

Tumor load was defined as the percentage of prostate volume invaded by cancer (PPI-PCA) in the surgical specimen. Pathologic features including tumor upgrading, upstaging or positive surgical margins in the specimen defined unfavorable disease (UD). PSA, TT, PSA density (PSAD), TTD, percentage of biopsy positive cores (BPC), PV and body mass index (BMI). The association of factors with the risk UD and HTL was evaluated by statistical methods.

Results

The cohort included 144 consecutive low-risk PCA patients. Overall, 104 patients (72.2%) had at least one feature indicating UD. TTD was associated with BMI, TT, PSA, PV and PPI-PCA ≥ 20% defined as HTL. A higher PPI-PCA was associated with an increased risk of UD with a fair discriminant power (area under the curve, AUC = 0.775; p < 0.0001). Patients with PPI-PCA > 20% were considered the study group versus patients with a PPI-PCA < 20% (control group). BPC, PSAD and TTD were independently associated with the risk of HTL (PPI-PCA ≥ 20%) with receiver-operating characteristics (ROC) curves indicating the same discriminant power for BPC (AUC = 0.628; p = 0.013), PSAD (AUC = 0.611; p = 0.032) and TTD (AUC = 0.610; p = 0.032).

Conclusions

Among low-risk PCA patients, TTD is associated with the risk of HTL, which is an independent predictor of UD and should be evaluated in the management of these patients.

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Abbreviations

AS:

Active surveillances

AUC:

Area under the curve

BMI:

Body mass index

BPC:

Biopsy positive cores

EAU:

European association of urology

ePLND:

Extended pelvic lymph node dissection HTL—high tumor load

ISUP:

International society of urologic pathology

LNI:

Lymph node invasion

PW:

Prostate weight

PCA:

Prostate cancer

PPI-PCA:

Percentage of prostate volume invaded by prostate cancer

PSA:

Prostate-specific antigen

PSAD:

PSA density

PV:

Prostate volume

RARP:

Robot-assisted radical prostatectomy

ROC:

Receiver-operating characteristics

RP:

Radical prostatectomy

RRP:

Retropubic radical prostatectomy

TT:

Total testosterone

TTD:

Total testosterone density

UD:

Unfavorable disease

WW:

Watchful waiting

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The authors did not receive financial support.

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Author notes

  1. Antonio B. Porcaro and Alessandro Tafuri contributed equally to this manuscript.

Authors and Affiliations

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

    Antonio B. Porcaro, Alessandro Tafuri, Marco Sebben, Tania Processali, Marco Pirozzi, Nelia Amigoni, Riccardo Rizzetto, Filippo Migliorini, Salvatore Siracusano & Walter Artibani

  2. USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Alessandro Tafuri & Aliasger Shakir

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

    Matteo Brunelli

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  1. Antonio B. Porcaro
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Contributions

ABP: project development, data analysis and interpretation, manuscript writing. AT: project development, data collection, data analysis and interpretation, manuscript writing. MS, MP, TP, NA, and RR: data collection. AS: data collection and language and critical revision. MB, FM, SS, and WA: other (supervision and critical revision).

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Correspondence to Antonio B. Porcaro.

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Porcaro, A.B., Tafuri, A., Sebben, M. et al. Total testosterone density predicts high tumor load and disease reclassification of prostate cancer: results in 144 low-risk patients who underwent radical prostatectomy. Int Urol Nephrol 51, 2169–2180 (2019). https://doi.org/10.1007/s11255-019-02263-6

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