局限性前列腺癌（PCa）一线治疗后的失败率仍然很高；因此，必须改进高危患者的选择和识别以降低死亡率。 ANDROCAN 研究的目的是根据术前性腺状态评估接受全前列腺切除术治疗的局限性 PCa 患者术后 5 年的生化复发 (BCR)。一项前瞻性队列研究包括 1318 名接受全前列腺切除术的患者。局部 PCa 术后 5 年随访。术前基线收集临床和激素数据（通过气相色谱/质谱法测定总睾酮 [TT]、生物可利用睾酮 [BT]、二氢睾酮、雌酮和雌二醇）以及代谢综合征参数。病理数据（主要是格里森4级和分期）被集中收集和交叉引用。通过多变量分析评估与 BCR 相关的因素，并通过 Kaplan-Meier 分析评估无 BCR 生存期。 在 1318 名患者中，237 名患有 PCa 的 BCR。考虑到人口特征，有和没有 BCR 的人群相似。然而，BCR 患者在基线时患有的癌症具有较高的格里森评分 (p = 0.0001) 和较高的前列腺特异性抗原 (PSA) 值 (p = 0.0005)。格里森评分、pT > 3a 和基线 PSA 水平与 BCR 呈正相关（分别为 p < 0.0001、p < 0.0001 和 p = 0.0048），而 BT 和 TT 水平与 BCR 无关。这项研究包括具有不同临床特征的患者，例如癌症病史和代谢综合征，引入的变异性使得分离性腺状态对 BCR 的具体影响变得具有挑战性。另一个限制是缺乏对超过 5 年的长期 BCR 的评估，可能会忽略术后 5 至 15 年之间发生的复发。这可能导致低估实际的长期复发率。总体而言，PSA 水平、高格里森评分和 pT >3a 与初始治疗后疾病复发的可能性更大相关，并且可以作为预测疾病的重要预后指标。 BCR 的风险。在这项前瞻性研究中，生化性腺功能减退症与前列腺切除术后 5 年内较高的 BCR 发生率无关。术前患者的生物学性腺状态可能对治疗决策有用，但不能为肿瘤学随访提供指示。术后对患者的五年随访显示，性腺功能减退症（总睾酮水平低）与性腺功能减退之间没有关联。和生物可利用的睾酮）和癌症复发。然而，癌症复发似乎与检测时癌症的侵袭性更相关。版权所有 © 2024 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。

Failure rates after first-line treatment of localized prostate cancer (PCa) treatment remain high; therefore, it is essential to improve the selection and identification of at-risk patients to reduce mortality. The aim of the ANDROCAN study was to evaluate the biochemical recurrence (BCR) in patients with localized PCa treated by total prostatectomy at 5 yr after surgery, according to their presurgery gonadal status.A prospective cohort study was conducted including 1318 patients undergoing total prostatectomy for localized PCa with a 5-yr postoperative follow-up. Clinical and hormonal data (assays of total testosterone [TT], bioavailable testosterone [BT], dihydrotestosterone, estrone, and estradiol were performed by gas chromatography/mass spectrometry) as well as metabolic syndrome parameters were collected at baseline before surgery. Pathological data (predominant Gleason grade 4 and stage) were collected and cross-referenced centrally. Factors associated with BCR were assessed by a multivariate analysis, and BCR-free survival was assessed by a Kaplan-Meier analysis.Among the 1318 patients, 237 had BCR of PCa. Considering demographic characteristics, populations with and without BCR were similar. However, patients with BCR had cancers with a higher Gleason score (p = 0.0001) and higher prostate-specific antigen (PSA) values (p = 0.0005) at baseline. Gleason score, pT >3a, and PSA level at baseline were positively correlated with BCR (p < 0.0001, p < 0.0001, and p = 0.0048, respectively), while BT and TT levels were not associated with BCR. This study includes patients with varying clinical characteristics, such as cancer history and metabolic syndrome, introducing variability that makes it challenging to isolate the specific effects of gonadal status on BCR. Another limitation is the lack of evaluation of long-term BCR beyond 5 yr, potentially overlooking recurrences that occur between 5 and 15 yr after surgery. This could lead to an underestimation of the actual long-term recurrence rates.Overall, PSA levels, high Gleason score, and pT >3a are associated with a greater likelihood of disease recurrence following initial treatment and could serve as important prognostic indicators for predicting the risk of BCR. In this prospective study, biochemical hypogonadism was not associated with a higher occurrence of BCR within 5 yr of prostatectomy. The biological gonadal status of preoperative patients could potentially be useful for therapeutic decisions but does not provide an indication for the oncological follow-up.Five-year follow up of patients after surgery showed that there is no association between hypogonadism (low levels of total testosterone and bioavailable testosterone) and cancer recurrence. However, cancer recurrence seems to be more associated with aggressiveness of cancer at the time of detection.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.