Association between prostate-specific antigen and serum testosterone: A systematic review and meta-analysis

Area of Science:

• Endocrinology
• Urology

Background:

• Serum testosterone assays are crucial for diagnosing endocrine disorders like male hypogonadism.
• Clinical utility of serum testosterone is limited by assay inaccuracy.
• This study investigates the relationship between prostate-specific antigen (PSA) and testosterone levels, and the impact of different testosterone replacement therapies (TRT) on PSA.

Purpose of the Study:

• To assess the association between PSA and testosterone.
• To evaluate the effects of various TRT types on PSA levels.
• To explore the potential of PSA as a surrogate marker for testosterone.

Main Methods:

• Systematic review of two databases: PubMed and Cochrane Library (up to December 2018).
• Two strategies were employed: 1) comparing PSA increase with TRT versus placebo, and 2) analyzing the association between PSA and testosterone in observational studies.
• Included 22 articles for TRT effects and 18 studies for PSA-testosterone association.

Main Results:

• TRT significantly altered PSA levels compared to placebo (MD: 0.13, P=0.04).
• Intramuscular (IM) TRT showed a significant PSA change (MD: 0.16, P=0.04), unlike oral or topical TRT.
• No overall correlation between PSA and testosterone was found (r=0.039).
• A significant correlation was observed between PSA and testosterone in the non-benign prostate hyperplasia (BPH) subgroup (r=0.089).

Conclusions:

• TRT, particularly IM TRT, significantly impacts PSA levels.
• A significant correlation exists between PSA and testosterone in non-BPH patients.
• PSA may be a potential surrogate marker for testosterone levels.