Influence of serum testosterone on urinary continence and sexual activity in patients undergoing radical prostatectomy for clinically localized prostate cancer

Abstract

The aim of the present study was to evaluate how serum testosterone level (T) can affect urinary continence and erectile function in patients undergoing radical prostatectomy (RP). We included 257 patients with clinically localized prostate cancer, those who had filled out preoperative quality of life questionnaires (University of California, Los Angeles Prostate Cancer Index, International Index of Erectile Function (IIEF)), and those who had T and total PSA sampled the day before surgery. We calculated correlations between T and age, body mass index (BMI), PSA, urinary function or bother (UF, UB) and sexual function or bother (SF, SB) and IIEF-5 in the whole population and in sub-populations with normal (X10.4 nmol l À1 ) and low (o10.4 ng ml À1 ) T using Pearson's and Spearman's correlation coefficients. We evaluated differences in these parameters between patients with low and normal T using the unpaired samples t-test and Mann-Whitney test, and finally the correlation between UF and SF, UB and SB, and between PSA and T in the overall population, and separately in patients with low and normal T using the Pearson's correlation coefficient. Mean preoperative T was 13.5 nmol l À1 and 23.7% of patients presented a low T. Mean age, mean BMI and mean preoperative total PSA at RP were 64.3 years, 25.9 kg m À2 and 9.0 ng ml À1 , respectively. BMI was negatively correlated with T in the overall population (r ¼ À0.266; P ¼ 0.02); moreover, patients with normal T presented lower BMI compared with patients with low T (25.7 vs 27.6: P ¼ 0.02). We found a significant correlation between SF scores and T in patients with normal T (r ¼ 0.1777: P ¼ 0.05). SF was significantly higher in patients with normal T compared with those with low T (74.8 vs 64.8: P ¼ 0.05). Furthermore, UF and UB were significantly correlated with SF (r ¼ 0.2544: Po0.01) and SB (r ¼ 0.2512: P ¼ 0.01), respectively, in men with normal T. Serum T was significantly correlated with PSA in men with low T (r ¼ 0.3874: P ¼ 0.0029), whereas this correlation was missed in the whole population and in men with normal T. The correlation between preoperative PSA and T in men with low T is in agreement with the 'saturation' model proposed by Morgentaler. The correlation between basal T and preoperative erectile function and urinary continence underlines the importance of assessing T before RP.

Testosterone Deficiency in Men: Systematic Review and Standard Operating Procedures for Diagnosis and Treatment

“…([46], EBMl3b) that in men with SD and no apparent prostate disease serum PSA is significantly correlated with serum T only in younger men, and in the first decile of T concentrations, and does not increase for serum concentrations above the level of 8 to 10 nmol/L (2.32 to 2.88 ng/mL) suggest a saturation level higher than that proposed by Morgentaler and Traish [165]. The same group also reported that in men with actual PCa, PSA was correlated with T only below the level of 10.4 nmol/L (3 ng/mL) ([172], EBMl3b). Lastly, in another population of men with localized PCa, no correlation between PSA and any of 5 different androgens was found, while following 6 months of ADT, a significant correlation was observed between PSA and the five androgens (T and DHT, but also DHEA‐S and androstenedione) ([173], EBMl2b).…”

Changes in sex hormone levels after radical prostatectomy: Results of a longitudinal cohort study

“…This explanation would also justify the increased gonadotropin levels observed with the normal Te levels in previous studies at 6 and 12 months following RP (9,12). In addition to possessing significance in endocrinological terms, the fluctuation of the Te levels in the first 3 months following RP may be important from a clinical perspective, since this period of time has critical relevance in the recovery of urinary continence and potency (21), and the resultant Te levels are significantly involved in the recovery of these functions (4,5). Although the present study did not record data on the functional recovery of these patients, we suggest that future investigations into the correlation between functional recovery and sex hormones should focus on the first months after prostatectomy.…”

“…The serum level of testosterone (Te) may affect sexual function in males treated by radical prostatectomy (RP) for clinically localized prostate cancer (PCa) (3). It has been suggested that Te may also affect urinary continence and increase bladder compliance following RP, with a relaxing effect in smooth muscle bladder cells through the nitric oxide synthase/nitric oxide pathway (4,5). Moreover, certain authors have reported a significant correlation between Te levels and adverse pathological features and biochemical recurrence, even though the prognostic value of pre-operative Te remains unclear (6–7).…”

Age Is Predictive of Immediate Postoperative Urinary Continence after Radical Retropubic Prostatectomy

“…It has been reported that the hypogonadism in the elderly or during androgen deprivation therapy impairs urinary function [22]. Gacci et al [23] evaluated how serum testosterone affected urinary continence in 257 patients who underwent RRP. They found a strong association between urinary continence and sexual potency in eugonadal patients and the lack of this correlation in hypogonadal men.…”