title: Serum 17β-estradiol fails as a marker in identification of aggressive tumour disease in patients with localized prostate cancer.
abstract: BACKGROUND
  There is evidence that obesity is associated with an aggressive prostate cancer (PC). Furthermore, preclinical studies suggest that oestrogens may play a pivotal role in this context. The biological processes underlying these observations are not fully understood. We prospectively evaluated whether obesity and/or preoperative estradiol levels are associated with high-grade cancer in patients with clinically localized PC at the time they underwent radical retropubic prostatectomy (RRP).
  
  
  METHODS
  Preoperative sex hormone serum 17β-estradiol (E2) as well as body mass index (BMI) and waist circumference (WC) were assessed in a cohort of 746 consecutive men treated with RP from February 2011 to October 2014. The data were correlated with patient-specific and clinicopathologic variables.
  
  
  RESULTS
  A total of 746 patients underwent RRP. Median age was 68.0 years. Median E2 serum level was 18.3 ng/l (IQR 12.9-24.2 ng/l). Median BMI was 26.6 kg/m(2) (IQR 24.6-29.1 kg/m(2)), and the median WC was 103 cm (IQR 96-110 cm). Serum E2 below or above the normal range was not found more frequently in obese patients (high BMI: p = 0.62; large WC: p = 0.83). E2 was not associated with BMI in our cohort of patients (r = 0.07, p = 0.10) or WC (r = 0.07, p = 0.10). There was no association between preoperative serum E2 levels and tumour stage (p = 0.86, Fisher's exact), tumour grade (p = 0.37), lymph node involvement (p = 0.59) or Gleason score (p = 0.44). However, obesity correlated with tumour stage and grade (p = 0.036, Fisher's exact) and nodal metastasis (p = 0.039, Fishers' exact).
  
  
  CONCLUSIONS
  Pretreatment serum 17β-estradiol (E2) cannot be considered as a suitable marker for aggressive tumour disease in patients with localized prostate cancer.
authors.affiliation: Department of Urology, University of Ulm Medical School, Prittwitzstrasse 43, 89075, Ulm, Germany. thomas.schnoeller@gmail.com.
authors.forename: Thomas J
authors.identifier: http://orcid.org/0000-0003-3617-1111
authors.initials: TJ
authors.lastname: Schnoeller
authors.affiliation: Department of Urology, University of Münster Medical School, Münster, Germany.
authors.forename: Julie
authors.initials: J
authors.lastname: Steinestel
authors.affiliation: Department of Urology, University of Ulm Medical School, Prittwitzstrasse 43, 89075, Ulm, Germany.
authors.forename: Friedemann
authors.initials: F
authors.lastname: Zengerling
authors.affiliation: Department of Urology, University of Münster Medical School, Münster, Germany.
authors.forename: Andres J
authors.initials: AJ
authors.lastname: Schrader
authors.affiliation: Department of Urology, University of Ulm Medical School, Prittwitzstrasse 43, 89075, Ulm, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Jentzmik
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000150:complications / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015331:Cohort Studies; D004958:Estradiol / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000473:pathology; D011237:Predictive Value of Tests; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000150:complications / Q000473:pathology*; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D004958:Estradiol
keywords: Estradiol; Grade; High-grade prostate cancer; Prostate cancer; Prostatectomy; Sex hormone; Stage; Testosterone