title: Preoperative low serum testosterone is associated with high-grade prostate cancer and an increased Gleason score upgrading.
abstract: BACKGROUND
  To compare histological feature of prostate cancer (PCa) according androgenic status in patients who underwent radical prostatectomy (RP).
  
  
  METHODS
  Between March 2007 and September 2013, we prospectively analysed 937 patients who were referred to our centre for RP. Clinical, pathological and biological data have been prospectively collected. Preoperative total testosterone (TT) and bioavailable testosterone (BT) serum determinations were carried out. The threshold for low serum testosterone was set at TT<3 ng/ml. Preoperative PSA value was registered. Gleason score (GS) and predominant Gleason pattern were determined in prostate biopsies and in prostate tissue specimens, crosschecked by two uro-pathologists.
  
  
  RESULTS
  Nine hundred and thirty-seven consecutive patients were included. In all, 14.9% patients had low TT in the population. An exact match between biopsy and prostate specimens in GS grading was observed for 50.6% patients (n=474). Also, 40.9% of all patients were upgraded (n=383): 45.3% (n=63) in low serum testosterone patients and 40.1% (n=320) in normal serum testosterone patients. For prostate specimens, the proportion of patients with predominant Gleason pattern 4 was higher in patients with low TT compared with normal TT (41.7% vs 29.1%, P=0.0029). In all, 20.1% were upgraded from predominant Gleason pattern 3 on biopsies specimen to predominant Gleason 4 pattern on the prostate specimen in patients with low TT, whereas 11.6% were upgraded for normal TT patients (P=0.002).
  
  
  CONCLUSIONS
  Low serum testosterone is an independent risk factor for predominant Gleason pattern 4 on prostate specimen after RP and for upgrading from low- to high-grade cancer between prostate needle biopsies and RP specimen. This observation should be taken into account in localised PCa management, especially for active surveillance or when a nerve-sparing approach is considered.
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: A
authors.initials: A
authors.lastname: Pichon
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Neuzillet
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: H
authors.initials: H
authors.lastname: Botto
authors.affiliation: Department of Physiology, University Pierre and Marie Curie, Paris, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Raynaud
authors.affiliation: Department of Pathology, Foch Hospital, Suresnes, France.
authors.forename: C
authors.initials: C
authors.lastname: Radulescu
authors.affiliation: Department of Pathology, CHU de Fort-de-France, Fort-de-France, France.
authors.forename: V
authors.initials: V
authors.lastname: Molinié
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Herve
authors.affiliation: Department of Urology, Foch Hospital, Suresnes, France.
authors.forename: T
authors.initials: T
authors.lastname: Lebret
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015897:Comorbidity; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D057234:Preoperative Period; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*
chemical_list: D013739:Testosterone