Porcaro Antonio Benito, Petroziello Aldo, Brunelli Matteo, De Luyk Nicolò, Cacciamani Giovanni, Corsi Paolo, Sebben Marco, Tafuri Alessandro, Tamanini Irene, Caruso Beatrice, Ghimenton Claudio, Monaco Carmelo, Artibani Walter
Clinica Urologica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Urol Int. 2016;96(4):470-8. doi: 10.1159/000443742. Epub 2016 Feb 5.
The study aims to investigate the potential associations between preoperative plasma levels of total testosterone (TT) and biopsy Gleason score (bGS) upgrading in prostate cancer (PCA) patients undergoing radical prostatectomy (RP).
Exclusion criteria were treatment with 5α-reductase inhibitors, LH-releasing hormone analogues or testosterone replacement. Criteria of bGS upgrading were as follows: (i) bGS 6 to pathological Gleason score (pGS) >6, (ii) bGS 7 with pattern 3 + 4 to pGS 7 with pattern 4 + 3 or to pGS >7, (iii) bGS 7 with pattern 4 + 3 to pGS >7. Patients who showed bGS >7 were excluded from the cohort.
The study included 209 patients. Tumor upgrading was assessed in 76 (36.4%) cases of the entire cohort, in 51 out of 130 cases (39.2%) of the bGS 6 group and 25 out of 79 patients (31.6%) in the bGS 7 cluster. Logistic regression models showed that independent clinical covariates predicting the risk of bGS upgrading included TT (OR 1.058; p = 0.027) and prostate-specific antigen (PSA) density (OR 23.3; p = 0.008) as well as TT (OR 1.057; p = 0.029) with PSA (OR 1.061; p = 0.023). The model suggests that 1 unit increase in TT plasma levels increases the odds of bGS upgrading by 5.8 or 5.7%.
In summary, we have determined that high TT preoperative plasma levels independently predict bGS upgrading in men with PCA undergoing RP. Preoperative plasma levels of TT might be included as a potential marker for assessing the risk bGS upgrading.
本研究旨在调查接受根治性前列腺切除术（RP）的前列腺癌（PCA）患者术前血浆总睾酮（TT）水平与活检Gleason评分（bGS）升级之间的潜在关联。
排除标准为接受5α-还原酶抑制剂、促黄体生成素释放激素类似物或睾酮替代治疗。bGS升级的标准如下：（i）bGS 6至病理Gleason评分（pGS）>6，（ii）bGS 7（3+4模式）至pGS 7（4+3模式）或pGS>7，（iii）bGS 7（4+3模式）至pGS>7。bGS>7的患者被排除在队列之外。
该研究纳入了209例患者。在整个队列的76例（36.4%）病例中评估了肿瘤升级情况，bGS 6组的130例病例中有51例（39.2%），bGS 7组的79例患者中有25例（31.6%）。逻辑回归模型显示，预测bGS升级风险的独立临床协变量包括TT（比值比1.058；p=0.027）和前列腺特异性抗原（PSA）密度（比值比23.3；p=0.008），以及TT（比值比1.057；p=0.029）与PSA（比值比1.061；p=0.023）。该模型表明，TT血浆水平每增加1个单位，bGS升级的几率增加5.8%或5.7%。
总之，我们已经确定，术前TT血浆水平高可独立预测接受RP的PCA男性患者的bGS升级。术前TT血浆水平可能作为评估bGS升级风险的潜在标志物。
