title: Low serum total testosterone level as a predictor of upstaging and upgrading in low-risk prostate cancer patients meeting the inclusion criteria for active surveillance.
abstract: Active surveillance (AS) is currently a widely accepted treatment option for men with clinically localized prostate cancer (PCa). Several reports have highlighted the association of low serum testosterone levels with high-grade, high-stage PCa. However, the impact of serum testosterone as a predictor of progression in men with low-risk PCa has been little assessed.In this study, we evaluated the association of circulating testosterone concentrations with a staging/grading reclassification in a cohort of low-risk PCa patients meeting the inclusion criteria for the AS protocol but opting for radical prostatectomy.Radical prostatectomy (RP) was performed in 338 patients, eligible for AS according to the following criteria: clinical stage T2a or less, PSA<10ng/ml, two or fewer cancer cores, Gleason score (GS)≤6 and PSA density<0.2 ng/mL/cc. Reclassification was defined as upstaging (stage>pT2) and upgrading (GS≥7; primary Gleason pattern 4) disease. Unfavorable disease was defined as the occurrence of pathological stage>pT2 and predominant Gleason score 4. Total testosterone was measured before surgery.Low serum testosterone levels (<300 ng/dL) were significantly associated with upgrading, upstaging, unfavorable disease and positive surgical margins. The addition of testosterone to a base model, including age, PSA, PSA density, clinical stage and positive cancer involvement in cores, showed a significant independent influence of this variable on upstaging, upgrading and unfavorable disease.In conclusion, our results support the idea that total testosterone should be a selection criterion for inclusion of low-risk PCa patients in AS programs and suggest that testosterone level less than 300 ng/dL should be considered a discouraging factor when a close AS program is considered as treatment option.
authors: Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy.
authors: Matteo
authors: M
authors: Ferro
authors: Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
authors: Giuseppe
authors: G
authors: Lucarelli
authors: Department of Public Health, University of Naples 'Federico II', Naples, Italy.
authors: Dario
authors: D
authors: Bruzzese
authors: Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy.
authors: Giuseppe
authors: G
authors: Di Lorenzo
authors: Department of Urology, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
authors: Sisto
authors: S
authors: Perdonà
authors: University Hospitals Urology Institute, Cleveland, OH, USA.
authors: Riccardo
authors: R
authors: Autorino
authors: Division of Urology, Magna Graecia University, Catanzaro, Italy.
authors: Francesco
authors: F
authors: Cantiello
authors: Department of Urology, University of Naples 'Federico II', Naples, Italy.
authors: Roberto
authors: R
authors: La Rocca
authors: Department of Urology, "La Sapienza" University, Rome, Italy.
authors: Gian Maria
authors: GM
authors: Busetto
authors: Institute of Genetics and Biophysics "A. Buzzati Traverso", National Research Council, Naples, Italy.
authors: Amelia
authors: A
authors: Cimmino
authors: Department of Clinical Medicine, Medical Oncology Unit, University of Naples 'Federico II', Naples, Italy.
authors: Carlo
authors: C
authors: Buonerba
authors: Department of Emergency & Organ Transplantation - Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
authors: Michele
authors: M
authors: Battaglia
authors: Division of Urology, Magna Graecia University, Catanzaro, Italy.
authors: Rocco
authors: R
authors: Damiano
authors: Department of Urology, European Institute of Oncology, Via Ripamonti, Milan, Italy.|University of Milan, Milan, Italy.|University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania.
authors: Ottavio
authors: O
authors: De Cobelli
authors: Department of Urology, University of Naples 'Federico II', Naples, Italy.
authors: Vincenzo
authors: V
authors: Mirone
authors: Department of Translational Medical Sciences, University of Naples 'Federico II', Naples, Italy.
authors: Daniela
authors: D
authors: Terracciano
mesh_terms: D000368:Aged; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*; D057832:Watchful Waiting
chemical_list: D013739:Testosterone
keywords: active surveillance; prostate cancer; testosterone; upgrading; upstaging