George A M Lins de Albuquerque1, Giuliano B Guglielmetti2, João Arthur B A Barbosa3, José Pontes2, Arnaldo J C Fazoli2, Maurício D Cordeiro2, Rafael F Coelho2, Paulo Afonso de Carvalho2, Fábio P Gallucci2, Guilherme P Padovani2, Rubens Park2, José Cury4, Henrique Nonemacher5, Miguel Srougi6, William C Nahas7. 1. Assistant Physician, Urology Service, Hospital Universitário Getúlio Vargas/Universidade Federal do Amazonas (HUGV/UFAM), and Assistant Physician, Urology Service, Fundação Centro de Controle em Oncologia do Estado do Amazonas (FCECON), Manaus, AM, Brazil. 2. Assistant Physician, Urology Service, Instituto do Câncer do Estado de São Paulo (Icesp), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil. 3. Urology Resident Physcian, HC-FMUSP, São Paulo, SP, Brazil. 4. MD Urologist, HC-FMUSP. Head of the Sexual Medicine Group, São Paulo, SP, Brazil. 5. Fellow in Urologic Oncology, Icesp, HC-FMUSP, São Paulo, SP, Brazil. 6. Full Professor of Urology, FMUSP, São Paulo, SP, Brazil. 7. Full Professor of Urology, FMUSP, and Head of the Urologic Oncology Group at Icesp, São Paulo, SP, Brazil.
Abstract
OBJECTIVE: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. METHOD: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. RESULTS: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). CONCLUSION: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.
OBJECTIVE: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. METHOD: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. RESULTS: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). CONCLUSION:Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.