Free testosterone value before radical prostatectomy is related to oncologic outcomes and post-operative erectile function

Abstract

PurposeTo investigate whether free testosterone (FT) prior to radical prostatectomy was related to post-operative oncologic outcomes, erectile function and continence.MethodsThe data of 586 patients with available information underwent treatment in our center was retrospectively reviewed. Total testosterone (TT) was tested by chemiluminescence immunoassay, and FT value was calculated using Vermeulen’s formula. Post-operative continence and erectile function were evaluated by the requirement of pad and the IIEF-5 score at 12 months.ResultsThe median TT and FT value was 344 ng/dL (interquartile, IQR 314–374) and 6.9 ng/dL (IQR 6.4–7.3), and 106 patients (18.1%) and 152 patients (25.9%) were evaluated as having low TT and low FT based on current guidelines. Low TT and FT value were both related to older age (both p < 0.001), concomitant diabetes (p = 0.018 & 0.049), higher possibility of pre-operative erectile dysfunction (ED, both p < 0.001), higher pre-operative PSA value (both p < 0.001), higher clinical stage (both p < 0.001) and higher Gleason score in biopsy (both p < 0.001). Low FT was related to higher risk for pT3 (p = 0.020) and high Gleason score (p = 0.011) in logistic regression. The median follow-up duration was 52 moths (IQR 29–67) and FT was found to be an independent risk factor for biochemical recurrence (p = 0.005). In logistic regression TT was related to pre-operative ED (p = 0.010) and FT was related to post-operative ED (p = 0.001).ConclusionLow FT value before radical prostatectomy was related to adverse pathological outcomes, biochemical recurrence and post-operative ED.

Study on the relationship between sex hormone changes and erectile dysfunction in patients with chronic prostatitis/chronic pelvic pain syndrome

“…Martinez-Jabaloyas et al (23) found that the total testosterone (TT) levels were not related to sexual function in men with ED. And it has been reported that free testosterone (FT) has a predictive effect on the occurrence of ED after radical prostatectomy (15). Our study found that comparison between groups in CP/CPPS patients were not statistically significant (P>0.05).…”

“…( 14) . For example, free testosterone is one of the predictors of ED occurrence (15). However, there is still a lack of clinical investigations for CP/CPPS patients with ED, especially the relationship between various serum hormones and ED.…”

Hypogonadism, frailty, and postoperative outcomes among men undergoing radical nephrectomy

“…Prior research on low testosterone and surgical outcomes in the urologic literature has primarily focused on prostate cancer (PCa) and radical prostatectomy (RP) patients. Among RP patients, low testosterone has been shown to increase upgrading and upstaging at the time of surgery, delay time to return of urinary control, and increase risk of postoperative erectile dysfunction 18–20 . However, in our RN cohort, hypogonadism was associated with outcomes more commonly seen in the general population.…”

“…Among RP patients, low testosterone has been shown to increase upgrading and upstaging at the time of surgery, delay time to return of urinary control, and increase risk of postoperative erectile dysfunction. [18][19][20] However, in our RN cohort, hypogonadism was associated with outcomes more commonly seen in the general population. For example, low testosterone is a well-established risk factor for cardiovascular disease with multiple prior studies showing an increased risk of atherosclerosis, coronary artery disease, and major adverse cardiovascular events (MACEs).…”

Association between Basal Total Testosterone Levels and Prostate Cancer D’Amico Risk Classes

“…In addition, Wang et al [24] showed that patients with an annual testosterone reduction of more than 30 ng/dL had a nearly 5-fold increase in PCA risk. Moreover, recent evidence in the literature has demonstrated that low baseline serum levels of free testosterone are associated with an increased risk of high-grade PCA [25] as well as adverse pathologic features, functional outcomes, and biochemical recurrence [26].…”