The Impact of Baseline Endogenous Testosterone Levels on Risk Stratification in Pathological Organ-Confined Prostate Cancer: Results in 460 Patients Treated with Robot-Assisted Radical Prostatectomy

The objective is to test the role of baseline endogenous testosterone (ET) in discriminating adverse tumor grades and predicting disease progression in prostate cancer (PCa) patients, who harbored organ-confined disease at radical prostatectomy (RP). Between November 2014 and December 2019, data on PCa patients treated with robot-assisted RP at a single tertiary referral center were retrospectively analyzed. Baseline ET levels were coded as abnormal (<= 350 ng/dL) vs. normal (> 350 ng/dL) according to a standard consensus. In the surgical specimen, the International Society of Urological Pathology (ISUP) grade groups 3 and 4/5 were classified as unfavorable tumor grades. Disease progression was defined as biochemical recurrence/persistence and/or local recurrence and/or distant metastases. Multivariable logistic and Cox regression models were used. Overall, 460 patients were included. In the surgical specimen, adverse tumor grades were detected in 198 (43.0%) patients of whom 60 (13.0%) harbored ISUP grade group 4/5. Disease progression occurred in 62 (13.5%) patients. In multivariable regression models that adjusted for other available clinical and pathological factors, patients with abnormal baseline ET levels were less likely to associate with unfavorable tumor grades, as well as to experience PCa progression (hazard ratio: 0.49; 95% CI: 0.26-0.92; p = 0.026). In pathological organ-confined PCa, baseline ET levels predicted disease progression after discriminating unfavorable tumor grades. Accordingly, baseline ET is a risk factor that might further stratify patients diagnosed with PCa.