Details

Autor(en) / Beteiligte

• Dell’Atti, Lucio
• Maselli, Guevar
• Leone, Luca
• Scarcella, Simone
• Galosi, Andrea Benedetto

Titel

RELATIONSHIP BETWEEN TESTOSTERONE LEVELS AND PROSTATE CANCER IN PATIENTS AFFECTED BY ATYPICAL SMALL ACINAR PROLIFERATION

Ist Teil von

• Anticancer research, 2018-04, Vol.38 (4), p.2467

Ort / Verlag

Athens: International Institute of Anticancer Research

Erscheinungsjahr

2018

Quelle

Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals

Beschreibungen/Notizen

• Atypical small acinar proliferation (ASAP) is a diagnosis that occurs in about 1-5% of prostate biopsies. The guidelines recommend immediate repeat biopsy within 3-6 months after the initial diagnosis of ASAP(1). The current literature does not support the usefulness of clinical markers on predicting patients with ASAP that are more likely to progress to prostate cancer (PCa) (2). In many observational studies, high levels of testosterone have long been considered to be possible risk factors for PCa. However, recent studies show that PCa has often been associated with low testosterone levels (3). It is therefore important to define whether in the early stages of prostate carcinogenesis there is a relationship between testosterone levels and PCa. The present retrospective study, we wished to analyze the relationship between serum testosterone levels and the diagnosis of PCa after the first prostate biopsy in patients affected by ASAP. The medical records of 327 patients diagnosed with ASAP in an initial transrectal ultrasound-guided prostate biopsy (TRUSBx) for suspicious PCa were retrospectively reviewed. Patients with a history of biopsy, surgical treatment for prostatic disease, neoadjuvant therapy, and incomplete clinical data were excluded from our study. A total of 143 patients, mainly men, referred for erectile dysfunction in our andrology clinics, were eligible for this study. TS levels were measured preoperatively and also, patients have undergone prostate biopsy due to PCa suspicion. All patients enrolled in the study signed a consent form. TRUSBx was performed using an ultrasound machine equipped with a 5-9 MHz multi-frequency convex probe “end-fire”. Three experienced urologists performed a 14-core biopsy scheme, as first intention. This biopsy scheme was changed based on TRUS findings concerning the size of the prostate and the possible suspicious regions, and varied from 8 cores from a small prostate to 18 cores for large prostatic glands. The decision for a second biopsy was based on ASAP diagnosis in the initial biopsy. The second biopsy was performed within 3-6 months from the first one. Results: All patients had a second biopsy and were suitablefor further analysis. Pre-biopsy TS ranged widely from 153 to 968 ng/dl (median=462 ng/dl). TS levels were less than 299 ng/dl in 29 (20.3%), 300-399 ng/dl in 47 (32.9%), and equal to or greater than 400 ng/dl in 67 (46.9%) patients. Thus, low and normal TS groups were composed of 29 (20.3%) and 114 (79.3%) patients, respectively. There was no statistically significant association between pre-biopsy clinicopathologic parameters and pre-biopsy TS levels. The diagnosis of the second biopsy was ASAP in 36 patients (25.2%) and PCa in 52 patients (36.4%). The comparison between PCa patients and those with negative or an ASAP result in the second biopsy showed that men with cancer had significantly higher levels of TS (p<0.001). The cancer rate was 37.9% (50/132) in men whose biopsies involved more than 8 cores and was 18.2% (2/11) in those with 8 cores only. Finally, the rate of cancer detection was 24.2% (7/29) in low TS patients and 39.5% (45/114) in eugonadal patients (p<0.002). The Gleason score (GS) was assigned as follows: among patients with TS level ≤300 ng/dl, 57.1% (4/7) had a low GS, 28.6% (2/7) had a moderate GS, and 14.3% (1/7) had a high GS; among patients with TS level >300 ng/dl, 53.4% (24/45) had a low GS, 33.3% (15/45) had a moderate GS, and 13.3% (6/45) had a high GS. These findings were not statistically significant (p=0.623). According to our current knowledge, this is the first study to examine the TS level as a clinical predictor in identifying the risk of PCa progression in patients with ASAP. In literature, few studies reported an association between high-grade intra-prostatic neoplasia diagnosis and TS levels at the second biopsy in terms of cancer progression, but not between ASAP and TS levels (2, 3). Our experience prompts that eugonadal patients may have higher risk for PCa diagnosis on rebiopsy after ASAP than hypogonadal. This reliable biomarker is inexpensive, reproducible, and serves to avoid prostate biopsies, which are associated with significant morbidity including pain, bleeding, and infectious complications. However, further studies are required to define the complex mechanism between androgen hormones and genetic factors in PCa etiology.