Circulating total testosterone and PSA concentrations in a nationally representative sample of men without a diagnosis of prostate cancer.
BACKGROUND
The association between serum sex steroid hormones and PSA in a general population has not been described.


METHODS
Included were 378 men aged 40-85 years who participated in the National Health and Nutrition Examination Survey in 2001-2004, who did not have a prostate cancer diagnosis, and had not had a recent biopsy, rectal examination, cystoscopy, or prostate infection or inflammation. Serum total PSA, total testosterone, androstanediol glucuronide (3α-diol-G), estradiol, and sex hormone binding globulin (SHBG) concentrations were previously measured. Free testosterone was estimated by mass action. We applied sampling weights and calculated geometric mean PSA concentration by hormone quintiles adjusting for age and race/ethnicity, and also for body mass index, waist circumference, smoking, diabetes, and mutually for hormones. We estimated the OR of PSA ≥2.5 ng/ml per hormone quintile using logistic regression.


RESULTS
Geometric mean PSA increased across testosterone quintiles after age and race/ethnicity (Q1: 0.80, Q5: 1.14 ng/ml; P-trend = 0.002) and multivariable (Q1: 0.79, Q5: 1.16 ng/ml; P-trend = 0.02) adjustment; patterns were similar for free testosterone and 3α-diol-G. SHBG was inversely associated with PSA only after multivariable adjustment (Q1: 1.32, Q5: 0.82 nmol/L; P-trend = 0.01). Estradiol and PSA were not associated. The OR of PSA ≥2.5 ng/ml was 1.54 (95% CI 1.18-2.01) per testosterone quintile after age and race/ethnicity adjustment, and 1.78 (95% CI 1.16-2.73) after multivariable adjustment.


CONCLUSIONS
In this nationally representative sample, men with higher testosterone had higher PSA even after taking into account other hormones and modifiable factors. Men with higher SHBG had lower PSA, but only after multivariable adjustment.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sarah B
SB
Peskoe
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Corinne E
CE
Joshu
Department of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
Sabine
S
Rohrmann
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Katherine A
KA
McGlynn
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Sarah J
SJ
Nyante
Department of Laboratory Medicine, Harvard Medical School and Children's Hospital, Boston, Massachusetts.
Gary
G
Bradwin
Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.|Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Adrian S
AS
Dobs
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.|Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Norma
N
Kanarek
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.|Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
William G
WG
Nelson
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.|Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.|Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Elizabeth A
EA
Platz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015113:Androstane-3,17-diol / Q000031:analogs & derivatives / Q000097:blood; D015992:Body Mass Index; D015987:Effect Modifier, Epidemiologic; D004958:Estradiol / Q000097:blood; D005006:Ethnicity; D006801:Humans; D016015:Logistic Models; D008297:Male; D009749:Nutrition Surveys; D017430:Prostate-Specific Antigen / Q000097:blood*; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D013223:Statistics as Topic; D013739:Testosterone / Q000097:blood*
D012738:Sex Hormone-Binding Globulin; D015113:Androstane-3,17-diol; C028895:androstane-3,17-diol glucuronide; D013739:Testosterone; D004958:Estradiol; D017430:Prostate-Specific Antigen
men; prostate specific antigen; testosterone