The relationship of testosterone to prostate-specific antigen in men with sexual dysfunction.
BACKGROUND
Concern about a testosterone (T)-induced prostate-specific antigen (PSA) increase is often perceived as one of the main limitations in treating hypogonadism even when it is symptomatic, such as in subjects with sexual dysfunction (SD).


OBJECTIVE
The aim of this study was to evaluate the relationship between T and PSA levels in subjects with SD. Methods. We retrospectively evaluated the relationship between T and PSA in 2,291 subjects seeking medical care at our outpatient clinic for SD (sample A). The analysis was then repeated in a selected subpopulation of 1,421 subjects apparently free from prostatic diseases (sample B).


METHODS
The specific association between PSA levels, circulating androgens, and different clinical signs and symptoms of hypogonadism, as assessed by ANDROTEST structured interview, was evaluated.


RESULTS
In both samples A and B, subjects with higher PSA levels reported a lower prevalence of hypogonadism-related symptoms and signs, as well as higher total testosterone (TT), and analogue and calculated free T. However, when the association between PSA and T was evaluated as a function of T deciles, the upper nine groups had similar PSA values, with the lowest demonstrated a significantly reduced PSA (the lowest vs. the rest of the sample: 0.61[0.38-1.23] ng/mL vs. 0.86[0.57-1.44] ng/mL, and 0.51[0.30-0.94] ng/mL vs. 0.73[0.52-1.10] ng/mL, respectively, for samples A and B; both P < 0.0001). Furthermore, when the relationship between hypogonadism (TT < 8 nmol/L) and PSA levels was evaluated according to age, it was significant only in younger subjects, but not in the older ones.


CONCLUSIONS
Our data demonstrated that PSA is unrelated to T concentration across most of the T range, except for the most severely T deficient, and that a significant relationship between T and PSA is seen in younger but not in older men.
Corona
Giovanni
G
Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
Boddi
Valentina
V
Lotti
Francesco
F
Gacci
Mauro
M
Carini
Marco
M
De Vita
Giulia
G
Sforza
Alessandra
A
Forti
Gianni
G
Mannucci
Edoardo
E
Maggi
Mario
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D003430:Cross-Sectional Studies; D004542:Ejaculation / Q000502:physiology*; D007172:Erectile Dysfunction / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D012016:Reference Values; D012189:Retrospective Studies; D012735:Sexual Dysfunction, Physiological / Q000097:blood*; D020018:Sexual Dysfunctions, Psychological / Q000097:blood*; D013223:Statistics as Topic; D013739:Testosterone / Q000097:blood* / Q000172:deficiency
D014408:Biomarkers, Tumor; D013739:Testosterone; D017430:Prostate-Specific Antigen