The Influence of Endogenous Testosterone on Incidental Prostate Cancer after Transurethral Prostate Resection

Porcaro, Antonio Benito; Siracusano, Salvatore; Amigoni, Nelia; Tafuri, Alessandro; Rizzetto, Riccardo; Shakir, Aliasger; Tiso, Leone; Cerrato, Clara; Michele, Mario De; Bianchi, Alberto; Gallina, Sebastian; Brunelli, Matteo; Migliorini, Filippo; Artibani, Walter; Antonelli, Alessandro

doi:10.1159/000514391

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…Overall, the basic characteristics of the included studies are illustrated in Table-1. The included studies (21) were retrospective studies (8,16,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(36)(37), 1 was a prospective study (31), and 1 was a cross-sectional study (17) that were published between 2005 and 2021, with sample sizes ranging from 120 patients to 76.788 patients. Furthermore, mean age ranged from 66 years to 75.8 years, mean prostate volume ranged from 44.2mL to 110mL, and mean PSA level ranged from 2.9ng/mL to 21.47ng/mL.…”

Section: Study Characteristics and Methodological-quality Assessmentmentioning

confidence: 99%

“…In general, the methodological quality of the included studies was evaluated on the basis of the NOS. One study (31) acquired eight points and were considered high quality, twenty one studies (8,16,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(36)(37) acquired six or seven points and were considered moderate quality, and the remaining study (17) scored three and was considered low quality (Supplementary Material 2).…”

Section: Study Characteristics and Methodological-quality Assessmentmentioning

confidence: 99%

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Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

et al. 2022

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Background: This study aimed to explore the prevalence and clinical risk factors in patients diagnosed with incidental prostate cancer (IPC) during certain surgeries (transurethral resection of the prostate [TURP], open prostatectomy [OP], and holmium laser enucleation of the prostate [HoLEP]) after clinically suspected benign prostatic hyperplasia (BPH).Materials and Methods: Literature search of the MEDILINE, Web of Science, Embase, and Cochrane Library databases was performed to identify eligible studies published before June 2021. Multivariate adjusted odds ratios (ORs) and associated 95% confidence intervals (CIs) of the prevalence and clinical risk factors of IPC were calculated using random or fixed-effect models. Results: Twenty-three studies were included in the meta-analysis. Amongst the 94.783 patients, IPC was detected in 24.715 (26.1%). Results showed that the chance of IPC detection (10%, 95% CI: 0.07-4.00; P<0.001; I2=97%) in patients treated with TURP is similar to that of patients treated with HoLEP (9%, 95% CI: 0.07-0.11; P<0.001; I2=81.4%). However, the pooled prevalence estimate of patients treated with OP was 11% (95% CI: -0.03-0.25; P=0.113; I2=99.1%) with no statistical significance. We observed increased incidence of IPC diagnosis after BPH surgery amongst patients with higher prostatespecific antigen (PSA) level (OR: 1.13, 95% CI: 1.04-1.23; P=0.004; I2=89%), whereas no effect of age (OR: 1.02, 95% CI: 0.97-1.06; P=0.48; I2=78.8%) and prostate volume (OR: 0.99, 95% CI: 0.96-1.03; P=0.686; I2=80.5%) were observed. Conclusions: The prevalence of IPC was similar amongst patients undergoing TURP, HoLEP, and OP for presumed BPH. Interestingly, increased PSA level was the only independent predictor of increasing risk of IPC after BPH surgery rather than age and prostate volume. Hence, future research should focus on predictors which accurately foretell the progression of prostate cancer to determine the optimal treatment for managing patients with IPC after BPH surgery.

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Section: Study Characteristics and Methodological-quality Assessmentmentioning

confidence: 99%

Section: Study Characteristics and Methodological-quality Assessmentmentioning

confidence: 99%

Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

et al. 2022

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“…Moreover, aging itself is a risk factor, as well. 1,2,11,12 We previously investigated the relationship between preoperative ET and PCa showing that total ET is associated with the risk of unfavorable disease in the surgical specimen. 13–18 In this study, we specifically aimed to test whether an association between preoperative ET levels and the risk of cancer progression in elderly with PCa exists.…”

Section: Introductionmentioning

confidence: 99%

Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy

Porcaro

Panunzio

Bianchi

et al. 2023

Therapeutic Advances in Urology

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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.

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Endogenous testosterone density predicts unfavorable disease at final pathology in intermediate risk prostate cancer

et al. 2021

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Objective To test the hypothesis that endogenous testosterone (ET) density could be associated with tumor load (TL) in patients with intermediate risk (IR) prostate cancer (PCa). Materials and methods Endogenous testosterone density (ETD, ratio between ET and prostate volume [PV]), biopsy positive cores density (BPCD, the ratio between the number of positive cores and PV) and prostate-specific antigen density (PSAD, ratio between total PSA and PV) were retrospectively evaluated on a prospectively collected data on 430 patients with IR PCa submitted to radical prostatectomy (RP). Tumor load (TL) was measured as the percentage of prostatic volume occupied by cancer at final pathology. Unfavorable disease (UD) was defined as tumor upgrading (ISUP grading group 4, 5) and/or upstaging (pT3a or 3b) in prostate specimens. Associations were assessed by the logistic regression and linear regression models. Results Overall, UD, which was detected in 122 out of 430 IR patients (28.4%), was predicted by BPCD (odd ratio, OR = 1.356; 95% CI 1.048–1.754; p = 0.020) with a sensitivity 98.4% and overall accuracy 71.9%. On multivariate analysis, BPCD was independently predicted by PSAD (regression coefficient, b = 1.549; 95% CI 0.936–2.162; p < 0.0001), ETD (b = 0.032; 95% CI 0.023–0.040; p < 0.0001) and TL (b = 0.009; 95% CI 0.005–0.014; p < 0.0001). As BPCD increased, ETD and ET levels increased accordingly, but patients with BPCD > 1.0%/mL had significantly lower ET levels. Conclusions As ETD increased, BPCD and TL increased, accordingly; furthermore, patients with lower ET levels were more likely to have occult UD. The influence of tumor load, and unfavorable disease on ET and ETD needs to be addressed by further studies.

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The Influence of Endogenous Testosterone on Incidental Prostate Cancer after Transurethral Prostate Resection

Cited by 5 publications

References 29 publications

Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

Prevalence and risk factors of incidental prostate cancer in certain surgeries for benign prostatic hyperplasia: A systematic review and meta-analysis

Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy

Endogenous testosterone density predicts unfavorable disease at final pathology in intermediate risk prostate cancer

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