Is there a relationship between testosterone and androgen receptor with prostatectomy outcomes?

Introduction:   Prostate cancer has a variable natural history and, despite the existence of biochemical recurrence (BCR) predictors, they are still limited in predicting outcomes.  The role of testosterone in advanced prostate cancer is well known, however its role in localized prostate cancer is still uncertain.  In the present study, we evaluated the relationship of testosterone levels and androgen receptor (AR) expression with oncological and functional outcomes, in patients undergoing radical retropubic prostatectomy (RRP).

Materials and methods:   Through a retrospective study, patients who underwent RRP, who had at least two preoperative total testosterone dosages, were analyzed and compared according to testosterone levels, oncological and functional outcomes.  After analyzing data, tissue samples were selected in a biorepository to carry out the AR and the AR-V7 expression.

Results:   After applying exclusion criteria, 212 patients were included in the analysis.  Thirty-two patients (15.1%) had low testosterone levels and, in this group, a lower rates of erectile function recovery were observed at 24 months (53.1% vs. 71.7%; p = 0.037), a higher rate of BCR (21.9% vs. 9.4%; p = 0.041) and higher International Society of Urological Pathology (ISUP) grade in biopsy products.  The AR expression was higher in patients with low testosterone, but there was no difference in relapse rates.

Conclusions:   Lower levels of testosterone were related to lower rates of erectile function recovery at the end of 24 months after RRP, in addition to conferring higher rates of BCR and higher ISUP grades in biopsy.  Furthermore, patients with total testosterone < 300 ng/dL had higher expression of AR, but no difference in BCR rates.