Low pretreatment serum total testosterone is associated with a high incidence of Gleason score 8-10 disease in prostatectomy specimens: data from ethnic Chinese patients with localized prostate cancer

What's known on the subject? and What does the study add? Previous data from clinically localized prostate cancer (PCa) series treated with radical prostatectomy (RP) have suggested that low preoperative serum total testosterone level is associated with more aggressive PCa; however, the definition of low preoperative total testosterone level varied among these studies (from 220 ng/dL to 387 ng/dL). Moreover, no relevant data exist in the literature regarding ethnic Chinese patients. The study shows that the most widely used threshold for low pretreatment total testosterone level (total testosterone < 300 ng/dL) is not appropriate for ethnic Chinese patients, because it could not distinguish patients with more aggressive PCa from those with less aggressive disease. Setting the threshold at the level of total testosterone < 250 ng/dL works better, because pretreatment total testosterone < 250 ng/dL is associated with a significantly higher incidence of Gleason score 8-10 disease in RP specimens.

Objective: • To investigate the relationship between preoperative serum total testosterone level and prognostic factors of Chinese patients with clinically localized prostate cancer (PCa).

Patients and methods: • A total of 110 patients with localized PCa, treated by radical prostatectomy (RP), were included in this prospective study. • Clinical and pathological data from each patient were collected. Total testosterone was measured on the morning of surgery. • Total testosterone levels for each patient were compared using two thresholds: threshold 1 (total testosterone <300 ng/dL vs total testosterone ≥ 300 ng/dL) and threshold 2 (total testosterone <250 ng/dL vs total testosterone ≥ 250 ng/dL).

Results: • The median preoperative total testosterone level was 346 ng/dL. Gleason scores of ≤ 6, 7 and ≥ 8 were found in the RP specimens from 21 (19.1%), 67 (60.9%) and 22 (20.0%) patients, respectively. • Compared with those with low grade disease, patients with high grade disease (Gleason score ≥ 8) in RP specimens had a significantly lower preoperative total testosterone. • When comparing 35 patients with hypogonadism with 75 patients with eugonadism, classified by threshold 1, no significant relationships were found. • When comparing 18 patients with hypogonadism with 92 patients with eugonadism, classified by threshold 2, pathological Gleason score ≥ 8 tumours were more common in patients with hypogonadism.

Conclusion: • Setting the threshold for hypogonadism at the level of pretreatment serum total testosterone <250 ng/dL is appropriate for ethnic Chinese patients with localized PCa, because patients with pretreatment total testosterone <250 ng/dL are associated with a higher incidence of Gleason score 8-10 disease in RP specimens.