Urological Oncology

Abstract

Not everything concerning the function of autonomic nerves with regards to clitoral and vaginal function, secretion of pelvic glands, function and long-term fate of urethral smooth musculature, and interaction with rhabdosphincter and pelvic floor musculature is known to date. However, with increasing knowledge we know that it is important to preserve at least part of the ganglions and nerve fibers of pelvic autonomic nerves to increase the quality of life for these patients in the long-term. In addition, it is the long-term quality of life where functional outcome is important contrary to oncological outcome, which in the first few years seems to be dominant as quality of life studies have shown. Objectives: Preoperative low serum testosterone (TS) level has been reported to be associated with adverse pathologic results in patients with clinically localized prostate cancer (pCA) treated with radical prostatectomy (RP). However, prior studies failed to show prognostic impact of preoperative low TS in these patients. The aim of this study was to investigate the relationship between preoperative TS and prostate-specific antigen (PSA) failure in these patients. Methods: Of 304 patients diagnosed with clinically localized pCA who had been treated with RP alone, 272 patients whose preoperative TS level had been measured were eligible for this analysis. Postoperative TS levels were also available in 222 of the 272 patients. Cox proportional hazard model was used to elucidate factors predictive for PSA failure. Results: Of the 272 patients 49 had low (< 300 ng/dl) and 223 had normal preoperative TS level. In a stepwise multivariate analysis, preoperative TS (p = 0.021) was an independent and significant predictor of PSA failure along with RP Gleason score (p = 0.006), surgical margin status (p = 0.0001), and PSA (p = 0.0001). Five-year PSA failure-free survival rate of the patients with preoperative low TS (67.8%) was significantly worse than that with normal TS (84.9%) (p=0.035). Serum TS levels increased significantly after RP (p < 0.0001). The increment of TS level in preoperative low TS group was significantly greater than that in preoperative normal TS group (p = 0.0003).Conclusions: The current results demonstrated that preoperative TS level is an independent and significant predictor of PSA failure after RP in patients with clinically localized pCA. European Association of Urology.