title: Association between Basal Total Testosterone Levels and Tumor Upgrading in Low and Intermediate Risk Prostate Cancer.
abstract: OBJECTIVE
  The study aimed to evaluate associations of basal levels of total testosterone (TT) with tumor upgrading to high risk disease in low-intermediate risk prostate cancer (PCA).
  
  
  METHODS
  We retrospectively evaluated the records of 135 patients undergoing radical prostatectomy. Evaluated factors included age, body mass index, prostate specific antigen (PSA), TT, prostate volume, PSA density (PSAD), proportion of biopsy positive cores (P+), clinical tumor stage, and biopsy grading system (1 or 2). Factors associating with tumor upgrading were investigated by the multivariate logistic regression analysis.
  
  
  RESULTS
  Tumor upgrading rate to high risk disease was 8.9%. TT, PSA, and PSAD were associated with tumor upgrading. On multivariate analysis, independent factors predicting tumor upgrading were PSA (OR 1.324; p = 0.001) and TT (OR 1.005; p = 0.015). Basal TT was dichotomized up to the third quartile (TT > q3) vs. TT ≤ q3 (426.0 ng/dL). The assessed tumor upgrading risk model showed that TT dichotomized to third quartile (TT > q3 vs. TT ≤ q3) stratified the risk of tumor upgrading (OR 6.577; p = 0.010) along increasing levels of PSA (OR 1.3; p < 0.0001).
  
  
  CONCLUSIONS
  Low and intermediate risk PCA patients show a not negligible risk of tumor upgrading to high risk disease. In this particular subset of patients, basal levels of TT stratify the risk of tumor upgrading.
authors.affiliation: Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: Antonio Benito
authors.initials: AB
authors.lastname: Porcaro
authors.forename: Nicolò
authors.initials: N
authors.lastname: De Luyk
authors.forename: Paolo
authors.initials: P
authors.lastname: Corsi
authors.forename: Marco
authors.initials: M
authors.lastname: Sebben
authors.forename: Alessandro
authors.initials: A
authors.lastname: Tafuri
authors.forename: Tania
authors.initials: T
authors.lastname: Processali
authors.forename: Mattia
authors.initials: M
authors.lastname: Cerasuolo
authors.forename: Daniele
authors.initials: D
authors.lastname: Mattevi
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cerruto
authors.forename: Matteo
authors.initials: M
authors.lastname: Brunelli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siracusano
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy; D016009:Chi-Square Distribution; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D016017:Odds Ratio; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013739:Testosterone / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D013739:Testosterone
keywords: Active surveillance; Class risk; Prostate cancer; Radical prostatectomy; Tumor upgrading