Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy
Background: The impact of senior age on prostate cancer (PCa) oncological outcomes following radical prostatectomy (RP) is controversial, and further clinical factors could help stratifying risk categories in these patients. Objective: We tested the association between endogenous testosterone (ET) a...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-02-01
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| Series: | Therapeutic Advances in Urology |
| Online Access: | https://doi.org/10.1177/17562872231154150 |
| _version_ | 1828009783663263744 |
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| author | Antonio Benito Porcaro Andrea Panunzio Alberto Bianchi Clara Cerrato Sebastian Gallina Emanuele Serafin Giovanni Mazzucato Stefano Vidiri Damiano D’Aietti Rossella Orlando Davide Brusa Matteo Brunelli Salvatore Siracusano Vincenzo Pagliarulo Maria Angela Cerruto Alessandro Tafuri Alessandro Antonelli |
| author_facet | Antonio Benito Porcaro Andrea Panunzio Alberto Bianchi Clara Cerrato Sebastian Gallina Emanuele Serafin Giovanni Mazzucato Stefano Vidiri Damiano D’Aietti Rossella Orlando Davide Brusa Matteo Brunelli Salvatore Siracusano Vincenzo Pagliarulo Maria Angela Cerruto Alessandro Tafuri Alessandro Antonelli |
| author_sort | Antonio Benito Porcaro |
| collection | DOAJ |
| description | Background: The impact of senior age on prostate cancer (PCa) oncological outcomes following radical prostatectomy (RP) is controversial, and further clinical factors could help stratifying risk categories in these patients. Objective: We tested the association between endogenous testosterone (ET) and risk of PCa progression in elderly patients treated with RP. Design: Data from PCa patients treated with RP at a single tertiary referral center, between November 2014 and December 2019 with available follow-up, were retrospectively evaluated. Methods: Preoperative ET (classified as normal if >350 ng/dl) was measured for each patient. Patients were divided according to a cut-off age of 70 years. Unfavorable pathology consisted of International Society of Urologic Pathology (ISUP) grade group >2, seminal vesicle, and pelvic lymph node invasion. Cox regression models tested the association between clinical/pathological tumor features and risk of PCa progression in each age subgroup. Results: Of 651 included patients, 190 (29.2%) were elderly. Abnormal ET levels were detected in 195 (30.0%) cases. Compared with their younger counterparts, elderly patients were more likely to have pathological ISUP grade group >2 (49.0% versus 63.2%). Disease progression occurred in 108 (16.6%) cases with no statistically significant difference between age subgroups. Among the elderly, clinically progressing patients were more likely to have normal ET levels (77.4% versus 67.9%) and unfavorable tumor grades (90.3% versus 57.9%) than patients who did not progress. In multivariable Cox regression models, normal ET [hazard ratio (HR) = 3.29; 95% confidence interval (CI) = 1.27–8.55; p = 0.014] and pathological ISUP grade group >2 (HR = 5.62; 95% CI = 1.60–19.79; p = 0.007) were independent predictors of PCa progression. On clinical multivariable models, elderly patients were more likely to progress for normal ET levels (HR = 3.42; 95% CI = 1.34–8.70; p = 0.010), independently by belonging to high-risk category. Elderly patients with normal ET progressed more rapidly than those with abnormal ET. Conclusion: In elderly patients, normal preoperative ET independently predicted PCa progression. Elderly patients with normal ET progressed more rapidly than controls, suggesting that longer exposure time to high-grade tumors could adversely impact sequential cancer mutations, where normal ET is not anymore protective on disease progression. |
| first_indexed | 2024-04-10T08:43:59Z |
| format | Article |
| id | doaj.art-b6b16cc61e6d42e2a4231b3ff9791bf2 |
| institution | Directory Open Access Journal |
| issn | 1756-2880 |
| language | English |
| last_indexed | 2024-04-10T08:43:59Z |
| publishDate | 2023-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Urology |
| spelling | doaj.art-b6b16cc61e6d42e2a4231b3ff9791bf22023-02-22T15:03:14ZengSAGE PublishingTherapeutic Advances in Urology1756-28802023-02-011510.1177/17562872231154150Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomyAntonio Benito PorcaroAndrea PanunzioAlberto BianchiClara CerratoSebastian GallinaEmanuele SerafinGiovanni MazzucatoStefano VidiriDamiano D’AiettiRossella OrlandoDavide BrusaMatteo BrunelliSalvatore SiracusanoVincenzo PagliaruloMaria Angela CerrutoAlessandro TafuriAlessandro AntonelliBackground: The impact of senior age on prostate cancer (PCa) oncological outcomes following radical prostatectomy (RP) is controversial, and further clinical factors could help stratifying risk categories in these patients. Objective: We tested the association between endogenous testosterone (ET) and risk of PCa progression in elderly patients treated with RP. Design: Data from PCa patients treated with RP at a single tertiary referral center, between November 2014 and December 2019 with available follow-up, were retrospectively evaluated. Methods: Preoperative ET (classified as normal if >350 ng/dl) was measured for each patient. Patients were divided according to a cut-off age of 70 years. Unfavorable pathology consisted of International Society of Urologic Pathology (ISUP) grade group >2, seminal vesicle, and pelvic lymph node invasion. Cox regression models tested the association between clinical/pathological tumor features and risk of PCa progression in each age subgroup. Results: Of 651 included patients, 190 (29.2%) were elderly. Abnormal ET levels were detected in 195 (30.0%) cases. Compared with their younger counterparts, elderly patients were more likely to have pathological ISUP grade group >2 (49.0% versus 63.2%). Disease progression occurred in 108 (16.6%) cases with no statistically significant difference between age subgroups. Among the elderly, clinically progressing patients were more likely to have normal ET levels (77.4% versus 67.9%) and unfavorable tumor grades (90.3% versus 57.9%) than patients who did not progress. In multivariable Cox regression models, normal ET [hazard ratio (HR) = 3.29; 95% confidence interval (CI) = 1.27–8.55; p = 0.014] and pathological ISUP grade group >2 (HR = 5.62; 95% CI = 1.60–19.79; p = 0.007) were independent predictors of PCa progression. On clinical multivariable models, elderly patients were more likely to progress for normal ET levels (HR = 3.42; 95% CI = 1.34–8.70; p = 0.010), independently by belonging to high-risk category. Elderly patients with normal ET progressed more rapidly than those with abnormal ET. Conclusion: In elderly patients, normal preoperative ET independently predicted PCa progression. Elderly patients with normal ET progressed more rapidly than controls, suggesting that longer exposure time to high-grade tumors could adversely impact sequential cancer mutations, where normal ET is not anymore protective on disease progression.https://doi.org/10.1177/17562872231154150 |
| spellingShingle | Antonio Benito Porcaro Andrea Panunzio Alberto Bianchi Clara Cerrato Sebastian Gallina Emanuele Serafin Giovanni Mazzucato Stefano Vidiri Damiano D’Aietti Rossella Orlando Davide Brusa Matteo Brunelli Salvatore Siracusano Vincenzo Pagliarulo Maria Angela Cerruto Alessandro Tafuri Alessandro Antonelli Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy Therapeutic Advances in Urology |
| title | Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy |
| title_full | Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy |
| title_fullStr | Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy |
| title_full_unstemmed | Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy |
| title_short | Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy |
| title_sort | normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy |
| url | https://doi.org/10.1177/17562872231154150 |
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