Gao Yuan, Jiang Chen-Yi, Mao Shi-Kui, Cui Di, Hao Kui-Yuan, Zhao Wei, Jiang Qi, Ruan Yuan, Xia Shu-Jie, Han Bang-Min
Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
Asian J Androl. 2016 Jul-Aug;18(4):639-43. doi: 10.4103/1008-682X.169984.
Often, pathological Gleason Score (GS) and stage of prostate cancer (PCa) were inconsistent with biopsy GS and clinical stage. However, there were no widely accepted methods predicting upgrading and upstaging PCa. In our study, we investigated the association between serum testosterone and upgrading or upstaging of PCa after radical prostatectomy (RP). We enrolled 167 patients with PCa with biopsy GS ≤6, clinical stage ≤T2c, and prostate-specific antigen (PSA) <10 ng ml-1 from April 2009 to April 2015. Data including age, body mass index, preoperative PSA level, comorbidity, clinical presentation, and preoperative serum total testosterone level were collected. Upgrading occurred in 62 (37.1%) patients, and upstaging occurred in 73 (43.7%) patients. Preoperative testosterone was lower in the upgrading than nonupgrading group (3.72 vs 4.56, P< 0.01). Patients in the upstaging group had lower preoperative testosterone than those in the nonupstaging group (3.84 vs 4.57, P= 0.01). In multivariate logistic regression analysis, as both continuous and categorical variables, low serum testosterone was confirmed to be an independent predictor of pathological upgrading (P = 0.01 and P= 0.01) and upstaging (P = 0.01 and P = 0.02) after RP. We suggest that low serum testosterone (<3 ng ml-1 ) is associated with a high rate of upgrading and upstaging after RP. It is better for surgeons to ensure close monitoring of PSA levels and imaging examination when selecting non-RP treatment, to be cautious in proceeding with nerve-sparing surgery, and to be enthusiastic in performing extended lymph node dissection when selecting RP treatment for patients with low serum testosterone.
通常，前列腺癌（PCa）的病理Gleason评分（GS）和分期与活检GS及临床分期不一致。然而，目前尚无广泛接受的预测PCa升级和分期上升的方法。在我们的研究中，我们调查了血清睾酮与根治性前列腺切除术（RP）后PCa升级或分期上升之间的关联。我们纳入了2009年4月至2015年4月期间167例活检GS≤6、临床分期≤T2c且前列腺特异性抗原（PSA）<10 ng/ml-1的PCa患者。收集了包括年龄、体重指数、术前PSA水平、合并症、临床表现和术前血清总睾酮水平等数据。62例（37.1%）患者出现升级，73例（43.7%）患者出现分期上升。升级组的术前睾酮水平低于未升级组（3.72 vs 4.56，P<0.01）。分期上升组的术前睾酮水平低于未分期上升组（3.84 vs 4.57，P=0.01）。在多因素逻辑回归分析中，作为连续变量和分类变量，低血清睾酮均被证实是RP后病理升级（P = 0.01和P=0.01）和分期上升（P = 0.01和P = 0.02）的独立预测因素。我们建议，低血清睾酮（<3 ng/ml-1）与RP后升级和分期上升的高发生率相关。对于外科医生而言，在选择非RP治疗时，最好确保密切监测PSA水平和影像学检查；在选择RP治疗低血清睾酮患者时，进行保留神经手术要谨慎，并积极进行扩大淋巴结清扫。
