为了测试内源性总睾酮（ETT）在临床本地化病例行机器人辅助根治性前列腺切除术治疗的前列腺癌（PCa）进展的预测作用，我们在2014年11月至2019年12月期间对580位连续患者进行了评估。术前ETT水平分为≤350 ng/dL和>350 ng/dL两类。通过回归分析评估ETT水平与PCa进展风险（定义为任何生化复发和/或局部复发和/或远处转移等事件）以及其他临床和病理因素之间的关联。 术前ETT水平结果在173（29.8%）名患者中≤350 ng/dL。共有101（17.1%）病例出现疾病进展。进展患者更容易出现PSA水平＞10 ng/mL、不利的肿瘤分级（ISUP 4-5）和分期（pT3b）最终病理结果，但不太可能有ETT水平≤350 ng/mL。在临床多变量Cox回归模型中，ETT≤350 ng/mL在肿瘤进展方面呈现出统计学显著的保护作用（危险比：0.57，p = 0.013）。在活检（比值比[OR]：0.46，p = 0.028）或最终病理学（OR：0.45，p = 0.032）中，ETT水平≤350 ng/mL的受试者不太可能患有ISUP 4-5肿瘤分级。 在PCa诊断时，与ISUP肿瘤分级相关的ETT是疾病进展的独立预测因子。因此，随着ETT降至≤350 ng/dL水平，不利的肿瘤分级风险降低，预后也会更为有利。术前ETT水平可能允许进一步将患者分层为预后风险组。© 2023年作者（以独家许可证授予施普林格自然杂志有限公司）。

To test the role of endogenous total testosterone (ETT) as a predictor of prostate cancer (PCa) progression in patients treated with robot assisted radical prostatectomy for clinically localized disease.Between November 2014 and December 2019, 580 consecutive patients were evaluated. Preoperative ETT levels were classified as ≤ 350 ng/dL vs. > 350 ng/dL. The associations between ETT levels and the risk of PCa progression, defined as any event of biochemical recurrence and/or local recurrence and/or distant metastases, or other clinical and pathological factors were evaluated by regression analyses.Preoperative ETT levels resulted ≤ 350 ng/dL in 173 (29.8%) patients. Disease progression occurred in 101 (17.1%) cases. Progressing patients were more likely to present with PSA levels > 10 ng/mL, as well as with unfavorable tumor grade (ISUP 4-5) and stage (pT3b) at final pathology, but less likely to have ETT levels ≤ 350 ng/mL. On clinical multivariable Cox regression models, ETT ≤ 350 ng/mL exhibited a statistically significant protective effect on tumor progression (hazard ratio: 0.57, p = 0.013). Subjects presenting with ETT levels ≤ 350 ng/mL were less likely to harbor ISUP 4-5 tumor grade either at biopsy (odds ratio [OR]: 0.46, p = 0.028) or final pathology (OR: 0.45, p = 0.032).At PCa diagnosis, ETT, which associates with ISUP tumor grade, is an independent predictor of disease progression. Accordingly, as ETT decreases to levels ≤ 350 ng/dL, the risk of unfavorable tumor grade decreases, and a more favorable prognosis is expected. Preoperative ETT levels may allow further patient stratification along prognostic risk groups.© 2023. The Author(s), under exclusive licence to Springer Nature B.V.