Baseline total testosterone is associated with high-grade prostate cancer and predicts disease progression: results and clinical implications in 500 patients treated with robotic surgery

La testosterona total basal se asocia con el cáncer de próstata de alto grado y predice la progresión de la enfermedad: resultados e implicaciones clínicas en 500 pacientes tratados con cirugía robótica

Background: To assess baseline total testosterone (TT) as a predictor of both adverse pathology and/or disease progression in an aging population diagnosed with clinical prostate cancer (PCa) treated with robotic surgery. Methods: From November 2014 to December 2021, 500 Caucasian patients underwent preoperative TT testing TT was categorized as subnormal (up to 12 nmol/L) versus normal (above 12 nmol/L). Adverse pathology was defined as adverse tumour grade (International Society of Urological Pathology (ISUP) grade 4/5) or tumour stage (extracapsular extension, seminal vesicle invasion) or pelvic lymph node invasion. Associations between the risk of adverse surgical pathology and disease progression were evaluated using appropriate statistical methods. Results: Median ( Interquartile Range (IQR)) baseline TT was 14.0 nmol/L (10.6–15.5 nmol/L) with levels being subnormal in 165 (33.0%) and normal in 335 (67%) patients who were more likely to have adverse tumour grades (Odds Ratio (OR) = 2.246, 95% Confidence Interval (CI) 1.123–4.490, p = 0.022) as well as to progress (Hazard Ratio (HR) = 1.757, 95% CI 1.199–2.577, p = 0.004) after a mean follow-up of 71.5 months. The prognostic impact of baseline TT remained unchanged after adjusting for standard clinicopathological factors. Conclusions: Baseline TT was associated with high-grade tumour features and independently predicted disease progression. These findings suggest that baseline TT may help refine risk stratification in patients with prostate cancer, although further validation is needed to clarify its role in prostate cancer biology.

Resumen
Antecedentes: Evaluar la testosterona total basal (TT) como predictor tanto de patología adversa como de progresión de la enfermedad en una población de varones de edad avanzada diagnosticados de cáncer de próstata clínicamente localizado (CP) y tratada con cirugía robótica. Métodos: Entre noviembre de 2014 y diciembre de 2021, se evaluó la TT preoperatoria en 500 pacientes caucásicos, clasificándola como subnormal (≤12 nmol/L) o normal (>12 nmol/L). La patología adversa se definió como un grado tumoral adverso (International Society of Urological Pathology (ISUP) 4/5), estadio tumoral adverso (extensión extracapsular o invasión de vesículas seminales) o invasión de ganglios linfáticos pélvicos. Las asociaciones con el riesgo de patología quirúrgica adversa y progresión de la enfermedad se evaluaron mediante métodos estadísticos. Resultados: La TT basal mediana (Intervalo intercuartílico (RIC)) fue de 14.0 nmol/L (10.6–15.5 nmol/L), con niveles subnormales en 165 pacientes (33.0%) y normales en 335 (67%). Los pacientes con TT subnormal presentaron una mayor probabilidad de presentar grados tumorales adversos ((OR) odds ratio = 2.246; Intervalo de confianza (IC) 95% 1.123–4.490; p = 0.022), así como una mayor probabilidad de progresión de la enfermedad ((HR) Hazard Ratio = 1.757; IC 95% 1.199–2.577; p = 0.004) tras un seguimiento medio de 71.5 meses. El impacto pronóstico permaneció sin cambios después del ajuste por factores estándar. Conclusiones: La TT basal se asoció con características tumorales de alto grado y predijo de forma independiente la progresión de la enfermedad. Estos hallazgos sugieren que la TT basal podría ayudar a refinar la estratificación del riesgo en pacientes con cáncer de próstata, aunque se necesitan estudios adicionales para aclarar su papel en la biología del cáncer de próstata.

Clinical prostate cancer; Baseline total testosterone; Aging male; Robot-assisted radical prostatectomy; Prostate cancer progression

Palabras Clave
Cáncer de próstata clínico; Testosterona total basal; Envejecimiento masculino; Prostatectomía radical asistida por robot; Progresión del cáncer de próstata

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