Obesity strongly predicts clinically undetected multiple lymph node metastases in intermediate- and high-risk prostate cancer patients who underwent robot assisted radical prostatectomy and extended lymph node dissection

Tafuri, Alessandro; Amigoni, Nelia; Rizzetto, Riccardo; Sebben, Marco; Shakir, Aliasger; Gozzo, Alessandra; Odorizzi, Katia; Michele, Mario De; Gallina, Sebastian; Bianchi, Alberto; Ornaghi, Paola Irene; Brunelli, Matteo; Marco, Vincenzo De; Verratti, Vittore; Migliorini, Filippo; Cerruto, Maria Angela; Artibani, Walter; Antonelli, Alessandro; Porcaro, Antonio Benito

doi:10.1007/s11255-020-02554-3

Cited by 17 publications

(18 citation statements)

References 34 publications

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“…The results of our study support these findings; furthermore, in another large investigation, we have also shown that as severity of prostate growing disorders worsen, ET levels decrease, accordingly. So far, in the aging male, ET levels correlate to changing patterns involving BMI, gonadal axis and prostate growing disorders; so far, as factors defining the system worsen, the risk of disease progression increases, accordingly [23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…All these events will destabilize the saturation model and let the tumor progress to undifferentiation and locally advanced stage with high metastatic load. In smaller cohorts of patients, we have shown that obesity associated with the risk of mPLNM when anatomical staging was performed through ePLND [29]. Furthermore, we also demonstrated that overweight and obese patients were at increased risk of harboring mPLNM and lower ET levels when compared to normal weight cases [30].…”

Section: Discussionmentioning

confidence: 61%

Low endogenous testosterone levels are associated with the extend of lymphnodal invasion at radical prostatectomy and extended pelvic lymph node dissection

et al. 2021

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Objective To investigate clinical factors associated to lymphnodal metastasis load in patients who underwent to radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND). Materials and methods Between November 2014 and December 2019, ET was measured in 617 consecutive patients not under androgen deprivation therapy who underwent RP and ePLND. Lymphnode invasion (LNI) was codified as not present (N = 0) or with one (N = 1) or more than one metastatic node (N > 1). The risk of multiple pelvic lymph node metastasis (N > 1, mPLNM) was assessed by comparing it to the other two groups (N > 1 vs. N = 0 and N > 1 vs. N = 1). Then, we assessed the association between ET and lymphnode invasion for standard predictors, such as PSA, percentage of biopsy positive cores (BPC), tumor stage greater than 1 (cT > 1) and tumor grade group greater than two (ISUP > 2). Results Overall, LNI was detected in 70 patients (11.3%) of whom 39 (6.3%) with N = 1 and 31 (5%) with N > 1. On multivariate analysis, ET was inversely associated with the risk of N > 1 when compared to both N = 0 (odds ratio, OR 0.997; CI 0.994–1; p = 0.027) as well as with N = 1 cases (OR 0.994; 95% CI 0.989–1.000; p = 0.015). Conclusions In clinical PCa, the risk of mPLNM was increased by low ET levels. As ET decreased, patients had an increased likelihood of mPLNM. Because of the inverse association between ET and mPLNM, higher ET levels were protective against aggressive disease. The influence of locally advanced PCa with high metastatic load on ET levels needs to be explored by controlled trials.

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“…Also, we found out that the negative correlation between endogenous TT and BMI was lost in patients affected by iPCA. The missed association between BMI and endogenous TT may be related to the small number of cases as well as to impaired tumor dynamic changes occurring in patients with increasing BMI values, as we recently demonstrated [25,26]. According to modern theories of PCA biology, promotion, induction, and progression of PCA are related to the concept of disease continuum occurring at the prostate glands [27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Objective: The aim of the study was to test the hypothesis that endogenous total testosterone (TT) may relate to incidental prostate cancer (iPCA) in patients with lower urinary tract symptoms (LUTS) associated with prostate enlargement undergoing transurethral resection of the prostate (TURP). Methods: The hypothesis was tested in contemporary cohort of patients who underwent TURP because of LUTS due to prostate enlargement after excluding the suspect of PCA. In period running from January 2017 to November 2019, 389 subjects were evaluated. Endogenous testosterone was measured preoperatively between 8:00 and 10:00 o’clock in the morning. Relationships between TT and iPCA were evaluated by statistical methods. Results: Overall, iPCA was detected in 18 cases (4.6%) with clinical stage cT1a or International Society of Urologic Pathology (ISUP) < 2 in 11 patients (61.1%). Endogenous testosterone was inversely associated with age and BMI in the study population but not in the subgroup with iPCA in wholly endogenous TT strongly correlated to both number of chips involved by cancer (Pearson’s correlation coefficient, r = 0.553; p = 0.017) and ISUP > 2 (r = 0.504; p = 0.033). The positive association of endogenous TT with both tumor load and tumor grade was confirmed by the linear regression model with high-regression coefficients for the former (regression coefficient, b = 0.307; 95% confidence interval, 95% CI: 0.062–0.551; and p = 0.017) as for the latter (b = 5.898; 95% CI: 0.546–11.249; and p = 0.033). Conclusions: Preoperative endogenous TT is associated with features of iPCA. The influence of iPCA on endogenous testosterone needs to be addressed by a large multicenter prospective trial.

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Obesity strongly predicts clinically undetected multiple lymph node metastases in intermediate- and high-risk prostate cancer patients who underwent robot assisted radical prostatectomy and extended lymph node dissection

Cited by 17 publications

References 34 publications

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

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

Low endogenous testosterone levels are associated with the extend of lymphnodal invasion at radical prostatectomy and extended pelvic lymph node dissection

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

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