Porcaro Antonio Benito, De Luyk Nicolò, Corsi Paolo, Sebben Marco, Tafuri Alessandro, Processali Tania, Cerasuolo Mattia, Mattevi Daniele, Cerruto Maria A, Brunelli Matteo, Siracusano Salvatore, Artibani Walter
Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Urol Int. 2017;99(2):215-221. doi: 10.1159/000459632. Epub 2017 Mar 1.
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).
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.
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).
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.
本研究旨在评估总睾酮（TT）基础水平与低中危前列腺癌（PCA）患者肿瘤进展为高危疾病之间的关联。
我们回顾性评估了135例行根治性前列腺切除术患者的记录。评估因素包括年龄、体重指数、前列腺特异性抗原（PSA）、TT、前列腺体积、PSA密度（PSAD）、活检阳性核心比例（P+）、临床肿瘤分期和活检分级系统（1或2）。通过多因素逻辑回归分析研究与肿瘤进展相关的因素。
肿瘤进展为高危疾病的发生率为8.9%。TT、PSA和PSAD与肿瘤进展相关。多因素分析显示，预测肿瘤进展的独立因素为PSA（OR 1.324；p = 0.001）和TT（OR 1.005；p = 0.015）。将基础TT分为高于第三四分位数（TT > q3）与TT ≤ q3（426.0 ng/dL）。评估的肿瘤进展风险模型显示，随着PSA水平升高（OR 1.3；p < 0.0001），TT分为高于第三四分位数（TT > q3与TT ≤ q3）可分层肿瘤进展风险（OR 6.577；p = 0.010）。
低中危PCA患者肿瘤进展为高危疾病的风险不可忽视。在这一特定患者亚组中，基础TT水平可分层肿瘤进展风险。
