The role of the serum testosterone levels as a predictor of prostate cancer in patients with atypical small acinar proliferation at the first prostate biopsy

Abstract

The current literature does not support the usefulness of clinical markers on predicting which patients with atypical small acinar proliferation (ASAP) are more likely to progress to prostate cancer (PCa). Androgens have long been considered to be the potential risk factors for PCa. However, the role of testosterone is controversial. The present study aims to analyze the relationship between serum testosterone (TS) levels and the diagnosis of PCa after a first prostate biopsy in patients affected by ASAP. This retrospective study included 143 patients diagnosed with ASAP in an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa according to the European Association of Urology guidelines. Their TS levels, age, PSA, prostate volume, digital rectal examination, and prostate biopsy Gleason score (GS) were collected retrospectively for statistical analysis. All patients included in the study had a second biopsy and were suitable for further analysis. Re-biopsy was carried out 3–6 months after the first diagnosis of ASAP. Low and normal TS groups were composed of 29 (20.3%) and 114 (79.7%) patients, respectively. The diagnosis of the second biopsy was ASAP in 25.2% and PCa in 36.4% of patients. The comparison between patients with PCa and those with negative or an ASAP result in the second biopsy reported that men with cancer had significantly higher levels of TS (P < 0.001). However, there was no statistically significant association between GS postbiopsy and TS (P = 0.324). Our experience demonstrated that eugonadal patients may be a clinical risk factor for the diagnosis of PCa on re-biopsy after ASAP diagnosis than hypogonadal.

Serum testosterone and prostate-specific antigen levels are major risk factors for prostatic volume increase among benign prostatic hyperplasia patients

“…Dell'Atti et al. [ 45 ] reported that serum testosterone levels change significantly on patients with a confirmed diagnosis of prostate cancer on the second biopsy who were previously found with atypical small acinar proliferation during the first biopsy performed 6 months prior. The next step following the findings of this study should focus on evaluating the serum level of DHT and estradiol among BPH patients and their association with prostate volume.…”

The importance of histomorphological features and ERG expression in the diagnosis of malignancy in cases with atypical small acinar proliferation

“…Approximately 5% of prostate biopsies are diagnosed as ASAP due to the absence of adequate histomorphological parameters allowing differentiation of the atypical focus from PCa [ 8 ]. In this study, the ASAP rate was consistent with that in the literature (5.67%) [ 2 , 8 ].…”

CRMP4 CpG Hypermethylation Predicts Upgrading to Gleason Score ≥ 8 in Prostate Cancer

“…Prostate growth and differentiation are closely related to the dihydrotestosterone level. PCa patients with a smaller prostate volume have lower levels of testosterone and dihydrotestosterone and a limited secretion of prostatic growth factors, such as insulin and insulin-like growth factor ( 29 ). The low expression of these hormones results in a more adverse microenvironment, where only more invasive tumor cells can grow, and the occurrence of high-grade PCa may be promoted.…”