Renal & Urology NewsProstate Cancer Outcomes Worse with Higher Periprostatic vs. Serum Testosterone

Elevated Periprostatic Testosterone Correlates with Poor Prostate Cancer Outcomes Post-Radical Prostatectomy

A recent study unveils the connection between high levels of periprostatic testosterone and negative clinical outcomes following radical prostatectomy for prostate cancer. This adds a new layer to our understanding of prostate cancer’s etiology and may be significant for preoperative evaluations.

HCN Medical Memo
The identification of “sneaky testosterone physiology” opens new avenues for preoperative evaluation and risk assessment. This may alter the course of therapeutic decisions and potentially improve patient outcomes by tailoring treatment more specifically based on individual androgen physiology.

Key Points

• Researchers, led by Nima Sharifi, MD, studied 266 men undergoing radical prostatectomy and found that 20% had elevated testosterone levels in the prostatic dorsal venous complex, with 5% having levels 10 times higher than peripheral serum measurements.
• The team has coined the term “sneaky testosterone physiology,” indicating that this localized androgen physiology exposes the prostate to high levels of gonadal testosterone and correlates with worse clinical outcomes.
• Patients with a dorsal to peripheral testosterone ratio greater than 2 had significantly lower progression-free survival rates, outweighing other predictors like preoperative PSA and pathologic Gleason score.

“The potential implications for this finding are broad and profound. In men who already have androgen-dependent prostatic diseases such as benign prostatic hyperplasia or prostate cancer, knowledge of the absence, presence, and extent of this ‘sneaky’ [testosterone] physiology and total prostatic androgen exposure may further clarify an individual’s distinct natural history of the disease.”
– Nima Sharifi, MD, Scientific Director of the Desai Sethi Urology Institute at the University of Miami Miller School of Medicine in Miami, Florida

Additional Points

• Indicators of testicular shunting of testosterone directly to the prostatic venous plexus were observed, further evidenced by the presence of byproducts like isocaproic acid and 17-OH-progesterone.
• Men with varicoceles also demonstrated an enrichment of 17-OH-progesterone due to testicular blood backflow.

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