Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading.
Level 3 - non-randomized controlled study
Prospective observational cohort study evaluating a prognostic marker.
PubMed 26439747 · doi:10.1038/pcan.2015.44
What was done
Between March 2007 and September 2013, researchers prospectively enrolled 937 consecutive patients undergoing radical prostatectomy at a single center. Preoperative total testosterone (TT) and bioavailable testosterone were measured, with low serum testosterone defined as TT < 3 ng/ml. Gleason score (GS) and predominant Gleason patterns on pre-surgery biopsies and post-surgery prostate specimens were evaluated and cross-checked by two uro-pathologists.
What was found
Low TT was observed in 14.9% of patients. Exact GS concordance between biopsy and surgical specimen occurred in 50.6% (n=474), while 40.9% overall (n=383) were upgraded: 45.3% (n=63) in low TT vs. 40.1% (n=320) in normal TT. On prostatectomy specimens, predominant Gleason pattern 4 was significantly more frequent in low TT compared to normal TT patients (41.7% vs. 29.1%, P=0.0029). Upgrading from predominant pattern 3 on biopsy to predominant pattern 4 on surgical specimen occurred in 20.1% of low TT patients versus 11.6% of normal TT patients (P=0.002).
Why it matters
Preoperative low testosterone may identify men at higher risk of aggressive disease and biopsy undergrading, which has direct clinical implications for selecting patients for active surveillance or nerve-sparing surgery.
Limits
The study is limited by its single-center observational design and inclusion solely of surgical candidates. The abstract reports crude proportions without multivariable-adjusted odds ratios, confidence intervals, or longitudinal survival and recurrence endpoints.
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