title: Circulating estradiol, but not testosterone, is a significant predictor of high-grade prostate cancer in patients undergoing radical prostatectomy.
abstract: BACKGROUND
  The objective of this study was to assess the association between preoperative circulating levels of 17β-estradiol (E₂) and high-grade prostate cancer (HGPCa) (Gleason grade ≥ 4 + 3) at the time patients underwent radical retropubic prostatectomy (RRP).
  
  
  METHODS
  Serum total testosterone (tT), sex hormone-binding globulin (SHBG), and E₂ levels were measured the day before surgery (8-10 AM) in a cohort of 655 consecutive Caucasian- European patients who underwent RRP at a single institution. Logistic regression models were used to test the association between predictors (including age, body mass index, prostate-specific antigen [PSA], clinical tumor classification, biopsy Gleason sum, tT, SHBG, and E₂) and HGPCa. Serum E₂ was included in the model as both a continuous variable and a categorized variable (according to the most informative cutoff: 50 pg/mL).
  
  
  RESULTS
  Pathologic HGPCa was identified in 156 patients (23.8%). Patients with HGPCa had significantly higher PSA, clinical tumor classification, and biopsy Gleason sum than those without HGPCa (all P < .001). No other significant differences were observed between groups. At univariate analysis, continuously coded E(2) was not associated significantly with HGPCa (odds ratio [OR], 1.009; P = .25), whereas patients with E₂ levels ≥ 50 pg/mL had a 3.24-fold increased risk of HGPCa (P < .001). At multivariate analysis, E₂ was associated significantly with HGPCa both as a continuous predictor (OR, 1.02; P = .04) and as a categorical predictor (OR, 3.94; P < .001) after accounting for other variables. Conversely, tT and SHBG levels were not associated significantly with HGPCa.
  
  
  CONCLUSIONS
  E₂ was associated significantly with pathologic HGPCa, whereas SHBG and tT failed to demonstrate any association with HGPCa in patients who underwent RRP.
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy. salonia.andrea@hsr.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallina
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Nazareno
authors.initials: N
authors.lastname: Suardi
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Firas
authors.initials: F
authors.lastname: Abdollah
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004958:Estradiol / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013739:Testosterone / Q000097:blood
chemical_list: D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D004958:Estradiol; D017430:Prostate-Specific Antigen