Sex hormone-binding globulin is a significant predictor of extracapsular extension in men undergoing radical prostatectomy

Andrea Salonia, Andrea Gallina, Alberto Briganti, Giuseppe Zanni, Nazareno Suardi, Umberto Capitanio, Renzo Colombo, Roberto Bertini, Massimo Freschi, Giorgio Guazzoni, Patrizio Rigatti, Francesco Montorsi

Research output: Contribution to journalArticlepeer-review


OBJECTIVE • To examine the association between sex hormone-binding globulin (SHBG) and extracapsular extension (ECE) in men treated with retropubic radical prostatectomy (RRP). PATIENTS AND METHODS • Preoperative serum SHBG levels were measured in a cohort of 629 consecutive European Caucasian men [mean (range) age of 64 (41-78) years] who underwent RRP. • No patient received any hormonal neoadjuvant treatment. SHBG levels were measured the day before RRP (08:00-10:00 hours) in all cases at the same laboratory. • Logistic regression models tested the association between predictors [including age, prostate-specific antigen (PSA) level, clinical stage, biopsy Gleason sum, body mass index (BMI), and SHBG] and ECE. • Combined accuracy of predictors was tested in regression-based models predicting ECE at RRP. SHBG was included in the model both as a continuous and categorized variable (according to the most informative threshold level of 30 nmol/L). RESULTS • In all, 92 patients (14.6%) had ECE. The mean (standard deviation; median) serum SHBG levels were significantly higher in men with ECE compared with those with no ECE at 41.1 (14.7; 37.5) vs 36.4 (16.7; 34) nmol/L (P= 0.007; 95% confidence interval -8.00, -1.29). • Univariate analyses indicated that continuously coded SHBG was significantly [odds ratio (OR) 1.01; P= 0.03] associated with ECE, with a predictive accuracy of 60.1%. • At multivariate analyses, both continuous (OR 1.01; P= 0.03) and categorical SHBG (OR 3.22; P <0.001) were significantly associated with ECE, after accounting for age, PSA level, clinical stage, biopsy Gleason sum, and BMI. • Addition of continuously coded SHBG slightly increased the predictive accuracy of the base model based on clinically established predictors from 63.3% to 65.5% (2.0% gain; P= 0.48). • In contrast, a model based on categorized-SHBG showed bootstrap-corrected predictive accuracy of 68.4% (5.1% gain; P= 0.044). CONCLUSION • This study shows that SHBG might serve as a significant multivariate predictor of ECE in men with prostate cancer that undergo RRP.

Original languageEnglish
Pages (from-to)1243-1249
Number of pages7
JournalBJU International
Issue number8
Publication statusPublished - Apr 2011


  • extracapsular invasion
  • prostate cancer
  • radical prostatectomy
  • sex hormone-binding globulin
  • staging

ASJC Scopus subject areas

  • Urology


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