title: Obesity and hypogonadism are associated with an increased risk of predominant Gleason 4 pattern on radical prostatectomy specimen.
abstract: OBJECTIVE
  To compare histological features of prostate cancer according to both obesity, defined by a body mass index (BMI) ≥30 kg/m2, and androgenic status in patients who underwent radical prostatectomy.
  
  
  METHODS
  Between March 2007 and September 2013, clinical, pathological and biological data were prospectively collected for patients referred for radical prostatectomy in a single European center. Preoperative total testosterone (TT) and bioavailable testosterone (bioT) serum determinations were performed. The threshold for hypogonadism was set at TT <3 ng/mL. The preoperative PSA value was registered. Gleason score (GS) and predominant Gleason pattern (PrdGP) were determined in prostate tissue specimens, and crosschecked by two uro-pathologists. Statistical analyzes were done for PrdGP4 risk assessment.
  
  
  RESULTS
  A total of 937 consecutive patients were included. One hundred and thirty-five filled the criterion for obesity (14.4%), out of which 42 had TT <3 ng/mL (31.1%), while in non-obese patients, only 97 had TT <3 ng/mL (12.0%). In prostate specimens, mean GS was 6.8±0.5: 291 patients (31.1%) had a PrdGP4. The incidence of PrdGP4 was higher (p<0.001) in the 135 obese patients [50% when hypogonadal (p<0.02) or 42% when eugonadal (p<0.005)] than in non-obese patients (28.9% and 27.1%, respectively). In multivariable analyzis for PrdGP4 risk, obesity, TT <3 ng/mL, PSA, and age were independent risk factors.
  
  
  CONCLUSIONS
  Both obesity and hypogonadism are independent risk factors for PrdGP4 in patients who underwent radical prostatectomy and should be taken into account in localized prostate cancer management, to improve the therapeutic choice, especially when prostate sparing approach is considered.
authors.forename: Yann
authors.initials: Y
authors.lastname: Neuzillet
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Raynaud
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.forename: Audrey
authors.initials: A
authors.lastname: Pichon
authors.forename: Camelia
authors.initials: C
authors.lastname: Radulescu
authors.forename: Vincent
authors.initials: V
authors.lastname: Molinie
authors.forename: Henry
authors.initials: H
authors.lastname: Botto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D005602:France; D006801:Humans; D007006:Hypogonadism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009765:Obesity / Q000150:complications*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone