UROLOGICAL ONCOLOGY

Preoperative serum testosterone level as an independent predictor of treatment failure following radical prostatectomy
Yamamoto S, Yonese J, Kawakami S, Ohkubo Y, Tatokoro M, Komai Y, Takeshita H, Ishikawa Y, Fukui I
Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Eur Urol. 2007; 52: 696-701

• Objectives: Preoperative low serum testosterone (TS) level has been reported to be associated with adverse pathologic results in patients with clinically localized prostate cancer (pCA) treated with radical prostatectomy (RP). However, prior studies failed to show prognostic impact of preoperative low TS in these patients. The aim of this study was to investigate the relationship between preoperative TS and prostate-specific antigen (PSA) failure in these patients.
• Methods: Of 304 patients diagnosed with clinically localized pCA who had been treated with RP alone, 272 patients whose preoperative TS level had been measured were eligible for this analysis. Postoperative TS levels were also available in 222 of the 272 patients. Cox proportional hazard model was used to elucidate factors predictive for PSA failure.
• Results: Of the 272 patients 49 had low (< 300 ng/dl) and 223 had normal preoperative TS level. In a stepwise multivariate analysis, preoperative TS (p = 0.021) was an independent and significant predictor of PSA failure along with RP Gleason score (p = 0.006), surgical margin status (p = 0.0001), and PSA (p = 0.0001). Five-year PSA failure-free survival rate of the patients with preoperative low TS (67.8%) was significantly worse than that with normal TS (84.9%) (p=0.035). Serum TS levels increased significantly after RP (p < 0.0001). The increment of TS level in preoperative low TS group was significantly greater than that in preoperative normal TS group (p = 0.0003).
• Conclusions: The current results demonstrated that preoperative TS level is an independent and significant predictor of PSA failure after RP in patients with clinically localized pCA. European Association of Urology.
  
  
• Editorial Comment
  Testosterone levels and prostate cancer are a topic that attracts much attention and stirs controversy. This contribution from Tokyo, Japan adds to the multifaceted database. With a cut-off at 300 ng/dL total testosterone the authors found an inverse correlation of testosterone level and prostate cancer aggressivity as measured by Gleason score, positive surgical margins, PSA, and 5-year postoperative PSA failure status.
  Most interestingly, testosterone levels increased after radical prostatectomy. The postoperative increment of testosterone levels was significantly higher in the group with preoperative low testosterone. Clearly, these data deserve confirmation from other groups and elucidation of the mechanisms involved in testosterone level variation after radical prostatectomy.

Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany