Positive Association between Preoperative Total Testosterone Levels and Risk of Positive Surgical Margins by Prostate Cancer: Results in 476 Consecutive Patients Treated Only by Radical Prostatectomy

Abstract

Objective: To evaluate preoperative total testosterone (TT) as a predictor of positive surgical margins (PSM) in prostate cancer (PCA). Patients and methods: During the period from November 2014 to July 2017, preoperative TT was measured in 476 PCA patients undergoing only radical prostatectomy (RP) and including all risk classes. Surgical margins were stated negative, focal positive (single and less than 1 mL), and multifocal positive (more than 1). The risk of TT and clinical factors associated with the risk of PSM (focal or multifocal versus negative) was evaluated by the multinomial logistic regression model. Results: Overall, PSM were detected in 149 cases (31.3%), which included 99 patients with focal cancer invasion (20.8%) and 50 subjects with multifocal cancer invasion (10.5%). In univariate analysis, PSM associated with higher median levels of TT and prostate-specific antigen than controls. Multifocal PSM associated with higher rates of high-risk PCA (42%) than focal (22.2%) or control cases (18.3%). In multivariate analysis, TT was the only independent factor positively associated with the risk of focal PSM when compared to controls (OR 1.002; p = 0.035). TT (OR 1.003; p = 0.002) and high-risk PCA (OR 1.002; p = 0.047) were independent factors, which positively associated with the risk of multifocal PSM when compared to controls. Risk models were computed. Conclusions: In a large and contemporary cohort of patients elected to primary RP, TT was an ­independent positive factor associated with the risk of focal and multifocal PSM. TT associated with aggressive PCA biology.

Elevated prostate volume index and prostatic chronic inflammation reduce the number of positive cores at first prostate biopsy set: results in 945 consecutive patients

“…Moreover, since the peripheral zone is being exposed to higher testosterone levels, tumors with more aggressive biology are expected to occur in this zone. This hypothesis is supported by findings showing positive association between preoperative total testosterone levels more aggressive tumors in radical prostatectomy specimens ( 21 - 23 ).…”

The association between prostate weight and positive surgical margins in prostate cancer: A meta‐analysis

“…It was also implied that there was nonlinear relationship of prostate size with aggressiveness of PCa. A large and contemporary cohort indicated that preoperative TT, defined as a continuous variable, was correlated with the increased risk of focal and multifocal PSMs (Porcaro et al, ). Two studies (Ferro et al, ; Teloken et al, ) also suggested that low preoperative TT had the positive relationships with PSMs, but this association disappeared when TT was evaluated as a continuous variable in Italian study (Ferro et al, ).…”

Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report

“…In intermediate risk cases, the decision to perform an ePLND was based on preoperative nomograms showing a risk of lymph node invasion (LNI) > 5% [15]. In low-risk patients, ePLND was performed based on the presence of risk factors of tumor upgrading [16][17][18][19][20][21]. In both surgical procedures, dissected lymph nodes were sampled according to an anatomical template including bilateral external iliac (extending proximally to the crossing of the ureter), obturator, Marcille's, common iliac, and Cloquet's nodal stations.…”

“…The incidence of hospital readmission after RP between 30 and 90 days after RP ranges from 3.3 to 9.7%, [6][7][8][28][29][30][31][32][33]. Particularly, readmission rates after ORP range between 5.47 and 10.7% [8,28,29,32,33], and readmission rates after LRP vary between 8.2 and 10.7% [21,22]. Readmission rates after RARP are the most frequently reported and range from 2.7 to 8.8% [8,28,29,33].…”

“…Among perioperative factors, operating time, grade of predischarge complications, and LOHS have been shown to be positive independent predictors of the risk of RAD [6,7,32]. Additionally, the robotic approach, surgeon experience (evaluated using the number of procedures performed), and presence of a urologic unit were associated with an inverse risk of RAD [15,21,22]. In all the studies reviewed, a multivariate logistic regression model was used to determine the association of factors with hospital readmission.…”