Login to Access Video or Poster Abstract: MP14-07
Sources of Funding: This research was supported by the Intramural Research Program of the National Cancer Institute, NIH

Introduction

Previous studies have demonstrated hypogonadism to be associated with higher grade prostate cancer (PCa) on prostate biopsy. However, there is a lack of literature on how hypogonadism (HG) affects prostate imaging on multiparametric MRI (mpMRI). Here, we aim to determine the impact of hypogonadism on PCa detection on MRI and subsequent detection on MRI-TRUS fusion biopsy (FBx).

Methods

Clinical and pathologic data from a prospectively maintained, single-institution database were analyzed for patients who underwent FBx and standard biopsy (SBx) between 2007 and 2016. Patients with total testosterone (TT) measured within 90 days of mpMRI were included in the study. Patients were excluded if they received prior radiation or androgen deprivation therapy for prostate cancer. HG was determined by a TT level below 180 ng/dL. T2, DWI, and DCE scores were calculated from mpMRI and analyzed as binary variables.

Results

In our cohort, 522 patients had testosterone measured within 90 days of mpMRI, of which 80 (15.3%) were deemed to be HG. Compared to normogonadal (NG) patients, HG patients had comparable age (62.0 years, IQR 8.8 vs 65.0 years, IQR 10.0; p = 0.519) and PSA (6.66 ng/ml, IQR 6.38 vs 6.86 ng/ml IQR 5.33; p=0.523). Median TT was 171 ng/dL (IQR 46) in the HG cohort, and 311 ng/dL (IQR 131) in the NG cohort (p<0.001). Imaging results were not significantly different between the HG and NG cohorts: prostate volume on MRI was 49.5 cc (IQR 40) vs. 50.0 cc (IQR 33), p=0.621; DWI was 95.0% vs 93.2% positive, p=0.542; DCE was 96.3% vs 91.4% positive, p=0.136. There was a lower detection rate of clinically significant cancer on SBx in the HG group compared to the NG group (28.8% vs 37.2%). However, FBx detection rates were similar between the HG and NG cohorts (40.4% vs 43.6%). In our cohort, 78 patients underwent radical prostatectomy. Of these, HG patients had higher rates of positive margins, lymph node invasion, seminal vesical invasion and Gleason score upgrade on pathology (22.2% vs 14.9%, 11.1% vs 7.5%, 11.1% vs 6.0%, and 22.2% vs 12.5%).

Conclusions

While SBx cancer detection rate (CDR) was lower in HG patients, FBx CDR was comparable in HG and NG cohorts, suggesting that FBx may provide an advantage in HG patients. In addition, HG patients seem to have higher adverse pathologic criteria in our MRI-screened cohort. Future larger, multi-institutional studies will be necessary to fully ascertain the impact of HG on PCa detection and staging by mpMRI .

Funding

This research was supported by the Intramural Research Program of the National Cancer Institute, NIH