Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37126, Verona, Italy.
USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Int Urol Nephrol. 2019 Dec;51(12):2169-2180. doi: 10.1007/s11255-019-02263-6. Epub 2019 Aug 23.
The aim of this study is to evaluate the association between total testosterone density (TTD), defined as the ratio of serum TT to prostate volume (PV), and high tumor load (HTL) in low-risk prostate cancer (PCA) patients who underwent radical prostatectomy.
Tumor load was defined as the percentage of prostate volume invaded by cancer (PPI-PCA) in the surgical specimen. Pathologic features including tumor upgrading, upstaging or positive surgical margins in the specimen defined unfavorable disease (UD). PSA, TT, PSA density (PSAD), TTD, percentage of biopsy positive cores (BPC), PV and body mass index (BMI). The association of factors with the risk UD and HTL was evaluated by statistical methods.
The cohort included 144 consecutive low-risk PCA patients. Overall, 104 patients (72.2%) had at least one feature indicating UD. TTD was associated with BMI, TT, PSA, PV and PPI-PCA ≥ 20% defined as HTL. A higher PPI-PCA was associated with an increased risk of UD with a fair discriminant power (area under the curve, AUC = 0.775; p < 0.0001). Patients with PPI-PCA > 20% were considered the study group versus patients with a PPI-PCA < 20% (control group). BPC, PSAD and TTD were independently associated with the risk of HTL (PPI-PCA ≥ 20%) with receiver-operating characteristics (ROC) curves indicating the same discriminant power for BPC (AUC = 0.628; p = 0.013), PSAD (AUC = 0.611; p = 0.032) and TTD (AUC = 0.610; p = 0.032).
Among low-risk PCA patients, TTD is associated with the risk of HTL, which is an independent predictor of UD and should be evaluated in the management of these patients.
本研究旨在评估总睾酮密度（TTD）与低危前列腺癌（PCA）患者根治性前列腺切除术后高肿瘤负荷（HTL）之间的关系，TTD 定义为血清 TT 与前列腺体积（PV）的比值。
肿瘤负荷定义为手术标本中被癌症侵犯的前列腺体积百分比（PPI-PCA）。病理特征包括标本中肿瘤升级、升级或阳性切缘定义为不良疾病（UD）。PSA、TT、PSA 密度（PSAD）、TTD、活检阳性核心百分比（BPC）、PV 和体重指数（BMI）。通过统计学方法评估各因素与高危 UD 和 HTL 的相关性。
该队列纳入了 144 例连续的低危 PCA 患者。总体而言，104 例（72.2%）患者至少有一个提示 UD 的特征。TTD 与 BMI、TT、PSA、PV 和 PPI-PCA≥20%（定义为 HTL）相关。较高的 PPI-PCA 与 UD 风险增加相关，具有较好的判别能力（曲线下面积，AUC=0.775；p<0.0001）。将 PPI-PCA>20%的患者视为研究组，PPI-PCA<20%的患者视为对照组。BPC、PSAD 和 TTD 与 HTL（PPI-PCA≥20%）风险独立相关，ROC 曲线表明 BPC（AUC=0.628；p=0.013）、PSAD（AUC=0.611；p=0.032）和 TTD（AUC=0.610；p=0.032）具有相同的判别能力。
在低危 PCA 患者中，TTD 与 HTL 风险相关，是 UD 的独立预测因子，应在这些患者的管理中进行评估。
