Serum PSA as a predictor of testosterone deficiency

Area of Science:

• Endocrinology
• Urology
• Andrology

Background:

• The relationship between serum prostate-specific antigen (PSA) and testosterone (T) levels remains debated, with the saturation hypothesis suggesting relevance only at low T ranges.
• Investigating PSA as a potential biomarker for T levels is crucial for understanding male hormonal health.

Purpose of the Study:

• To determine if PSA levels reliably indicate T concentrations in a large cohort of men presenting with sexual dysfunction (SD).
• To explore the utility of PSA as a diagnostic tool for hypogonadism and associated conditions.

Main Methods:

• Analysis of 2,967 male patients with sexual dysfunction and PSA levels below 4 ng/mL.
• Evaluation of hormonal parameters, biochemical markers, and validated questionnaires (SIEDY, ANDROTEST, PsychoANDROTEST).

Main Results:

• Receiver operating characteristic curve analysis indicated PSA accuracy of 0.612 (P<0.0001) for predicting severe hypogonadism (T<8 nmol/L), with optimal sensitivity/specificity at PSA<0.65 ng/mL.
• Low PSA (<0.65 ng/mL) was associated with hypogonadism features, metabolic syndrome, type 2 diabetes, cardiovascular diseases, and impaired sexual/sleep-related erections, even after adjusting for T levels.
• The association between low PSA and hypogonadal symptoms, signs, and metabolic syndrome persisted after adjusting for T levels.

Conclusions:

• Serum PSA levels serve as a marker for circulating T concentrations and may offer a novel approach to confirming hypogonadism.
• PSA determination can provide insights into both total and active fractions of T, aiding in the assessment of hormonal status.