Serum sex steroids depict a nonlinear u-shaped association with high-risk prostate cancer at radical prostatectomy
Menée sur une cohorte de 724 patients atteints d'un cancer de la prostate traité par prostatectomie radicale, cette étude montre une association non linéaire entre les niveaux sériques préopératoires de stéroïdes sexuels et un risque élevé de récidive
PURPOSE. Assess the association between preoperative serum total testosterone (tT), 17betaestradiol (E2), sex hormone-binding globulin (SHBG), and tT-E2 ratio values with high-risk prostate cancer (PCa; as defined by the National Comprehensive Cancer Network practice guidelines) at radical prostatectomy (RP). METHODS. Serum E2, tT, and SHBG were dosed the day before surgery (7-11 AM) in a cohort of 724 candidates to RP. Restricted cubic spline functions tested the association between predictors (ie, model 1: age, body mass index [BMI], and serum tT, E2, and SHBG levels; Model 2: tT-E2 values instead of tT and E2 levels) and high-risk PCa. RESULTS. Low-, intermediate-, or high-risk PCa was found in 251 (34.7%), 318 (43.9%), and 155 (21.4%) patients, respectively. Patients in the high-risk class showed the lowest tT, E2, and tT-E2 ratio values (all p ≤ 0.02). At univariate analysis, only age, tT, E2, and tT-E2 ratio values were significantly associated with high-risk PCa (all p ≤ 0.006). At multivariate analyses considering model 1 variables, age (p = 0.03), serum tT (all p < 0.001), and E2 (all p ≤ 0.01) were associated with high-risk PCa; only tT-E2 ratios achieved independent predictor status for high-risk PCa (all p < 0.001) when considering model 2. Both the lowest and the highest tT, E2, and tT-E2 values depicted a nonlinear U-shaped significant association with high-risk PCa. CONCLUSIONS. These data showed that preoperative serum sex steroids are independent predictors of high-risk PCa, depicting a nonlinear U-shaped association.
Clinical Cancer Research , résumé, 2012