Department of Urology, Irvine Medical Center, University of California, Orange, CA, USA.
BJU Int. 2022 Jul;130(1):76-83. doi: 10.1111/bju.15626. Epub 2021 Nov 19.
To comprehensively assess total and calculated free testosterone levels in a consecutive group of patients with prostate cancer (PCa) and any potential impact on disease aggressiveness and recurrence outcomes.
The study included a single-centre prospective cohort of 882 patients presenting for radical prostatectomy from 2009 to 2018. Data on total testosterone (TT), sex hormone-binding globulin (SHBG), and calculated free testosterone (cFT) were prospectively collected. Stepwise logistic regression models were used to assess correlations of TT and cFT with pathological Gleason Grade Group (GGG), extraprostatic extension (EPE), seminal vesicle invasion (SVI) and biochemical recurrence (BCR).
Total testosterone remained nearly constant across decades (40s-80s): 0.09 decrease/year (R = 0.02), while SHBG increased 0.87/year (R = 0.32) and cFT decreased 0.08/year (R = -0.02). Low cFT of <5.5 independently predicted: very-high-risk GGG (odds ratio [OR] 0.435, 95% confidence interval [CI] 0.846-0.994; P = 0.036), EPE (OR 0.557, 95% CI 0.810-0.987; P = 0.011), SVI (OR 0.396, 95% CI 0.798-1.038; P = 0.059), and BCR within 1 year after robot-assisted radical prostatectomy (OR 0.638, 95% CI 0.971-3.512, P = 0.046). TT was not a predictor.
In contrast to popular belief, testosterone remained stable in men aged 40-80 years, whereas free testosterone decreased by 2-3%/year. Low cFT was an independent predictor of very-high-risk PCa and BCR.
全面评估连续一组前列腺癌 (PCa) 患者的总游离睾酮和计算游离睾酮水平，以及其对疾病侵袭性和复发结局的任何潜在影响。
本研究纳入了 2009 年至 2018 年间因根治性前列腺切除术而就诊的 882 例患者的单中心前瞻性队列。前瞻性收集总睾酮 (TT)、性激素结合球蛋白 (SHBG) 和计算游离睾酮 (cFT) 的数据。逐步逻辑回归模型用于评估 TT 和 cFT 与病理 Gleason 分级组 (GGG)、前列腺外延伸 (EPE)、精囊侵犯 (SVI) 和生化复发 (BCR) 的相关性。
总睾酮在几十年内几乎保持不变 (40 多岁至 80 多岁)：每年下降 0.09( R = 0.02)，而 SHBG 每年增加 0.87( R = 0.32)，cFT 每年下降 0.08( R = -0.02)。cFT<5.5 预测：极高风险 GGG(比值比 [OR] 0.435，95%置信区间 [CI] 0.846-0.994；P = 0.036)、EPE(OR 0.557，95%CI 0.810-0.987；P = 0.011)、SVI(OR 0.396，95%CI 0.798-1.038；P = 0.059) 和机器人辅助根治性前列腺切除术后 1 年内的 BCR(OR 0.638，95%CI 0.971-3.512，P = 0.046)。TT 不是预测因素。
与普遍看法相反，40-80 岁男性的睾酮水平保持稳定，而游离睾酮每年下降 2-3%。低 cFT 是预测极高危 PCa 和 BCR 的独立因素。
