Introduction

In localized prostate cancer (PCa), impact of biochemical hypogonadism on cancer emergence and progression is still controversial. We aim to compare preoperative sex hormones plasma profiles and pathological features in localized PCa patients according to gonadal status assessed by total (TT) and bioavailable (BT).

Methods

A new large prospective cohort study of 1125 (age 63.9, height 175 cm, weight 82,2 kg, BMI 26.8 30 kg/m2, waist circumference 101cm) localized PCa patients were recruited in 4 urological centre in France, from 6/2013-6/2016. Metabolic syndrome (MetS) parameters were collected. Assay of TT, BT, DHT, E1, and E2 were performed by GC-MS. A centralized cross- checked review of pathological data (Predominant Gleason pattern 4 (PrdGP4), stage) was done.

Results

The cohort has been divided in 4 groups; the 1st group consists of patients with T and BT in the normal range (? 3 ng/ml and BT ? 0,8 ng/ml), a low T in the 2nd, a low BT in the 3rd and both low T and BT in the 4th._x000D_ The percentages of PrdGP4 and pT?3a were one-third in the normal gonadal patients going statistically up to one half in the hypogonadal. A 10% weight increase, due to fat, occurred in the low T patients, while no change occurred in the low BT, indicating a dichotomy in the action of T and BT. _x000D_ A dramatic difference in SHBG concentration between low BT and low T concentrations was observed, conferring to SHBG a key role in selecting patients at a high risk of an aggressive PCa. In fact, when considering hypogonadal patients by a threshold of TT? 3 ng/ml only, we miss 90 patients (8%) that had low BT, because of a high SHBG, no Mets but, a high %PrdG4._x000D_

Conclusions

Thus, a serum low BT delineate a population of aggressive PCa risk more than obesity. Consequently, for treatment decision-making, in addition to TT and obesity, BT should be assessed in the arsenal for the management of localized PCa.

Funding

the Foch Foundation