Low PSA level in men diagnosed with prostate cancer predicts testosterone deficiency (TD)
Bernie, H1; Miranda, E1; Terrier , J2; Nelson, C1; Mulhall, J1
1: Memorial Sloan Kettering Cancer Center, United States; 2: Hospices Civils de Lyon
Objectives: PSA secretion is a testosterone (T) dependent process. There is published data suggesting that low serum total T level is an independent predictor of higher stage, higher grade prostate cancer. However, the link between men diagnosed with prostate cancer with low PSA values and T deficiency (TD) has not been explored before.
Material and Methods: All men diagnosed with prostate cancer since 2000 that had a record of pre-treatment early morning total T level measurement were included in the analysis. We analyzed demographic, clinical and pathological data. Patients were stratified according to pre-treatment PSA levels: 0-2; 2.1-4; >4 ng/ml. TD was defined as total T < 300 ng/dL. We evaluated the relationship between these PSA groups and TD. Age, diabetes, and hyperlipidemia were also included in both univariate and multivariable analyses.
Results: Mean age of 349 men was 64±8 years. The distribution by PSA group was: 5% (0-2), 16% (2.1-4), and 79% (>4). The mean T level across the entire cohort was 358±192 ng/dl. Overall, 38% had a T level < 300 ng/dl; 63% > 300 ng/dl. 9% had diabetes, 10% had hyperlipidemia. The mean T level by PSA group was: 265±168 (0-2); 328±210 (2.1-4); and 371±189 (>4), p=0.03. The percentage of men with TD by PSA group was: 53% (0-2); 49% (2.1-4); and 35% (>4), p=0.05. The percentage of men with extremely low T levels (<200) by PSA group was: 35% (0-2); 22% (2.1-4); and 13% (>4), p=0.01. Age, diabetes, and hyperlipidemia were not related to T level grouping on univariate analyses (p=0.35 to p=0.81). On multivariable analysis, PSA 0-2 compared to PSA >4: OR=2.1, 95% CI: 0.82-5.36, p=0.12; PSA 2.1-4 compared to PSA >4: OR=1.9, 95% CI: 1.02-3.34, p=0.04. PSA 0-2 compared to PSA >4 was not significant due to low sample size.
Conclusion: Low PSA levels predict TD in a cohort of patients with prostate cancer. This finding suggests a possible benefit of adding total T level measurement when a patient with low PSA is diagnosed with prostate cancer.
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