Elsevier

European Urology

Volume 47, Issue 3, March 2005, Pages 308-312
European Urology

Pretreatment Serum Testosterone Level as a Predictive Factor of Pathological Stage in Localized Prostate Cancer Patients Treated with Radical Prostatectomy

https://doi.org/10.1016/j.eururo.2004.11.003Get rights and content

Abstract

Objective:

Pretreatment serum level of testosterone (T) is a potential prognostic factor for prostate cancer. The present study was conducted to evaluate the clinical significance of pretreatment serum T level in patients with clinically localized prostate cancer.

Materials and Methods:

The subjects were 82 clinically localized prostate cancer patients treated with radical prostatectomy, whose pretreatment T levels were recorded. We investigated clinical and pathological factors such as pretreatment serum T level, age, pretreatment PSA or pathological Gleason score concerning the association with pathological stage and biochemical recurrence.

Results:

The mean pretreatment T level was significantly lower in patients with non-organ-confined prostate cancer (pT3–T4, N1; 3.44 ± 1.19 ng/ml) than in patients with organ-confined cancer (pT2; 4.33 ± 1.42 ng/ml) (p = 0.0078). Multivariate analysis demonstrated that pathological Gleason score, pretreatment serum T level and pretreatment PSA were significant predictors of extraprostatic disease. When the patients were divided into high and low T level groups according to the median value, pretreatment T levels were not significantly associated with PSA recurrence rates (p = 0.7973).

Conclusions:

A lower pretreatment T level appears to be predictive of extraprostatic disease in patients with localized prostate cancer.

Introduction

A number of clinical, endocrinological and pathological prognostic factors for prostate cancer have been reported [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Knowledge of these factors will likely contribute to determining the most appropriate therapy for individual patients. Several studies have identified relationships of pretreatment serum level of testosterone (T) with clinical stage of prostate cancer and patient survival, suggesting that pretreatment serum T level has potential as a prognostic factor for prostate cancer [1], [2], [3], [4], [5], [6], [7], [8], [9], [10].

There are epidemiological and genetic differences in prostate cancers between patients in Japan and the US. p53 gene mutational analysis, which often provides information about etiological factors, has revealed clear differences in p53 gene mutational spectra between Japanese and Western cases [17]. The usefulness of T level as a prognostic factor in Japanese prostate cancer patients has yet to be determined. In the present study of 82 Japanese localized prostate cancer patients who underwent radical prostatectomy as an initial treatment, we investigated the predictive value of pretreatment T level for pathological staging of clinically localized prostate cancer. In addition, we examined possible relationships between pretreatment serum T level and several clinical factors.

Section snippets

Materials and methods

The subjects were 82 patients (mean age, 66.6 ± 5.3 years; range, 50–77 years) with prostate cancer (ICD7 code 177) that was treated with radical prostatectomy at Chiba University Hospital between April 1996 and March 2004, whose pretreatment T levels were recorded. Patients who received neo-adjuvant treatment before surgery were excluded from the study.

Blood samples were taken in the morning. Serum T level was measured by radioimmunoassay using the DPC total testosterone kit (Nippon DPC Corp.,

Results

Overall pretreatment data for age and serum levels of total T and PSA are shown in Table 1. Table 2 shows surgical factors for all 82 patients. Pathological stages were as follows: pT2a, 36 patients (43.9%); pT2b, 22 patients (26.8%); pT3a, 14 patients (17.1%); pT3b, 9 patients (11.0%); pT4, 1 patient.

Table 3 shows nonparametric univariate analysis of the relationship of pretreatment T to clinical and pathological factors. The mean pretreatment T level was significantly lower in patients with

Discussion

Prostate cancer is one of the most common cancers among Western populations, and its incidence is increasing in Asia. Prostatic development and growth depend on androgenic stimulation. In 1941, Huggins et al. published the first report a relationship between serum T and prostate cancer [20]. Currently, the association of serum T with prostate cancer is incompletely understood. Adlercreutz et al. were the first to demonstrate that the mean serum T level was significantly higher in patients with

Conclusion

In the present study, total T was an independent significant predictor of extraprostatic disease in univariate and multivariate analyses. A lower pretreatment T level appears to be predictive of non-organ-confined disease in patients with localized prostate cancer. However, pretreatment serum T level was not associated with biochemical recurrence after radical prostatectomy.

Acknowledgements

This work was supported by a Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology (Contract grant numbers: 13671635 and 16591582) and the Haraguchi Memorial Fund (2003).

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