Prostate screening in patients with 46,XY disorders of sex development--is it necessary?
OBJECTIVE
We used current methods of screening for prostate cancer, digital rectal examination and serum prostate specific antigen as an initial assessment of risk in a young group of adult 46,XY patients affected by disorders of sex development.


METHODS
Adult intersex patients older than 21 years, under long-term followup at the Pediatric Endocrinology Clinic of the Johns Hopkins Hospital, with a diagnosis of male psuedohermaphroditism and raised as male or female were included in analysis. After written consent all participants underwent digital rectal examination and blood sampling for prostate specific antigen and testosterone measurements.


RESULTS
Prostate specific antigen values were available for analysis in 26 patients. Diagnoses included micropenis (8), complete androgen insensitivity syndrome (3), partial androgen insensitivity syndrome (9) and mixed gonadal dysgenesis (6). Of the 26 patients 9 had been raised as female (complete androgen insensitivity syndrome in 3, partial androgen insensitivity syndrome in 3, micropenis in 2 and mixed gonadal dysgenesis in 1). Mean patient age was 38 years (range 24 to 57). Serum prostate specific antigen was less than 0.1 ng/ml in 18 patients including the 9 reared as female. The remaining 8 patients had a prostate specific antigen of 0.1 to 0.9 ng/ml, were reared as male and had a mean age of 39.6 years (range 33 to 44). The diagnoses in this group consisted of micropenis (4), partial androgen insensitivity syndrome (2) and mixed gonadal dysgenesis (2). All patients had a palpable, small prostate gland with no abnormalities noted on digital rectal examination.


CONCLUSIONS
This study found measurable prostate specific antigen in a subset of male intersex patients that were comparable to controls matched for age and race. We recommend that patients with 46,XY disorder of sex development, reared as male, be screened for prostate cancer in a manner similar to men not affected by disorder of sex development.
Salmasi
Amirali Hassanzadeh
AH
Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutes, Baltimore, Maryland 21287, USA.
Wisniewski
Amy B
AB
Novak
Tomas E
TE
Gearhart
John P
JP
Migeon
Claude J
CJ
Lakshmanan
Yegappan
Y
D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D051517:Digital Rectal Examination; D012734:Disorders of Sex Development / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006061:Gonadal Dysgenesis, 46,XY / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000235:genetics; D012680:Sensitivity and Specificity; D046468:Sexual Development / Q000502:physiology; D013739:Testosterone / Q000097:blood*
D013739:Testosterone; D017430:Prostate-Specific Antigen