Circulating estradiol, but not testosterone, is a significant predictor of high-grade prostate cancer in patients undergoing radical prostatectomy

BACKGROUND: The objective of this study was to assess the association between preoperative circulating levels of 17β-estradiol (E ₂) and high-grade prostate cancer (HGPCa) (Gleason grade ≥;4 + 3) at the time patients underwent radical retropubic prostatectomy (RRP). METHODS: Serum total testosterone (tT), sex hormone-binding globulin (SHBG), and E ₂ levels were measured the day before surgery (8-10 AM) in a cohort of 655 consecutive Caucasian- European patients who underwent RRP at a single institution. Logistic regression models were used to test the association between predictors (including age, body mass index, prostate-specific antigen [PSA], clinical tumor classification, biopsy Gleason sum, tT, SHBG, and E ₂) and HGPCa. Serum E ₂ was included in the model as both a continuous variable and a categorized variable (according to the most informative cutoff: 50 pg/mL). RESULTS: Pathologic HGPCa was identified in 156 patients (23.8%). Patients with HGPCa had significantly higher PSA, clinical tumor classification, and biopsy Gleason sum than those without HGPCa (all P 2 was not associated significantly with HGPCa (odds ratio [OR], 1.009; P =.25), whereas patients with E ₂ levels ≥50 pg/mL had a 3.24-fold increased risk of HGPCa (P 2 was associated significantly with HGPCa both as a continuous predictor (OR, 1.02; P =.04) and as a categorical predictor (OR, 3.94; P 2 was associated significantly with pathologic HGPCa, whereas SHBG and tT failed to demonstrate any association with HGPCa in patients who underwent RRP. Cancer