The relationship between PSA and total testosterone levels in men with prostate cancer Journal Article
| Authors: | Flores, J. M.; Bernie, H. L.; Miranda, E.; Nascimento, B.; Schofield, E.; Benfante, N.; Carlsson, S.; Mulhall, J. P. |
| Article Title: | The relationship between PSA and total testosterone levels in men with prostate cancer |
| Abstract: | Background: Prostate-specific antigen (PSA) secretion is a testosterone (T) dependent process. Published data suggest that a low T level is an independent predictor of higher-grade prostate cancer (PC). Aim: To evaluate the relationship between T and PSA in patients with PC. Methods: All men diagnosed with PC with a recorded pre-treatment total T level measurement were included in this analysis. We analyzed demographic, clinical, and pathological data. Patients were stratified according to pretreatment PSA levels: <2 ng/mL, 2–4 ng/mL, >4 ng/mL. Low T was defined as total T < 10.4 nmol/L (300 ng/dL), very low T < 6.9 nmol/L (200 ng/dL). Outcomes: T levels by PSA groups according to the PC pathology. Results: In this retrospective study, mean patient age was 61 years among 646 men. The distribution by PSA group was: 8% (<2), 17% (2–4), and 76% (>4). The mean T level across the entire cohort was 13 nmol/L (374 ng/dL). Overall, 30% had a T level < 10.4 nmol/L (300 ng/dL). The mean total T level by PSA group was: <2 ng/mL, 7 nmol/L (206 ng/dL); 2–4 ng/mL, 13 nmol/L (362 ng/dL); >4 ng/mL, 14 nmol/L (393 ng/dL), P < .001. PSA <4 ng/mL was a significant predictor of low T in men with PC GS ≥8. PSA <2 ng/mL was a significant predictor of very low T independent of the PC pathology. Clinical Implications: These findings suggest that clinicians should consider measuring T levels when a patient diagnosed with PC GS ≥8 and PSA level <4 ng/mL, and for each patient with PSA level <2 ng/mL independent of the PC pathology. Strengths & Limitations: Our study has several strengths including (i) inclusion of a large population of men, (ii) use of a database which is audited and reviewed for accuracy annually, and (iii) use of an accurate T assay (LCMS). Nonetheless, there are limitations: (i) the subjects of the study are from a single institution, and (ii) we did not measure free T levels. Conclusion: In men with PC with GS ≥8, PSA level <4 ng/mL predicts low T. PSA <2 ng/mL predicts very low T independent of the PC pathology. Flores JM, Bernie HL, Miranda E, et al. The Relationship Between PSA and Total Testosterone Levels in Men With Prostate Cancer. J Sex Med 2022;19:471–478. © 2022 International Society for Sexual Medicine |
| Keywords: | adult; middle aged; major clinical study; prostate specific antigen; cohort analysis; pathology; retrospective study; prostate cancer; gleason score; clinical study; psa; testosterone blood level; hypogonadism; testosterone; androgen deficiency; demographics; human; male; article; testosterone deficiency; stratified sample; antigen blood level |
| Journal Title: | Journal of Sexual Medicine |
| Volume: | 19 |
| Issue: | 3 |
| ISSN: | 1743-6095 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-03-01 |
| Start Page: | 471 |
| End Page: | 478 |
| Language: | English |
| DOI: | 10.1016/j.jsxm.2022.01.003 |
| PUBMED: | 35135736 |
| PROVIDER: | scopus |
| PMCID: | PMC9359436 |
| DOI/URL: | |
| Notes: | Article -- Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers and the National Institutes of Health/National Cancer Institute to Memorial Sloan Kettering Cancer Center through the Cancer Center Support Grant, award number P30 CA008748. -- Source: Scopus |
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