Serum Testosterone: A Potentially Adjunct Screening Test for the Assessment of the Risk of Prostate Cancer Among Men with Modestly Elevated PSA Values (≥3.0 and <10.0 ng/ml)

• Published in: Anticancer research Vol. 26; no. 4B; pp. 3159 - 3166
• Main Authors: KARAMANOLAKIS, Dimitrios, LAMBOU, Theocharis, KOUTSILIERIS, Michael, BOGDANOS, John, MILATHIANAKIS, Constantine, SOURLA, Antigone, LEMBESSIS, Peter, HALAPAS, Antonis, PISSIMISSIS, Nicholas, DESSYPRIS, Nick, PETRIDOU, Eleni T. H
• Format: Journal Article
• Language: English
• Published: Attiki International Institute of Anticancer Research 01.07.2006
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biopsy - methods; Humans; Male; Mass Screening - methods; Medical sciences; Middle Aged; Neoplasm Staging; Nephrology. Urinary tract diseases; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Risk Factors; Testosterone - blood; Tumors; Tumors of the urinary system; Ultrasonography; Urinary tract. Prostate gland; Human; Urinary system disease; Androgen; Prostate disease; prostate cancer risk; Male; Tumoral marker; Malignant tumor; Medical screening; Epidemiology; Prostate specific antigen; Testosterone; Cancerology; Risk factor; Adult; Serum; Testicular hormone; Sex steroid hormone; Male genital diseases; Prostate cancer
• ISSN: 0250-7005; 1791-7530

Whether serum testosterone (T) can become an adjunct test able to validate the PSA-weighted risk of prostate cancer (PR.CA) in the “grey” diagnostic area (PSA =3.0 to <10.0 ng/ml) was investigated. Seven hundred and eighteen men participated in a prostate screening program using the cut-off PSA value of ≥3.0 ng/ml. PR.CA was found in 26% (22/85) of men with PSA testing within the “grey” diagnostic area and 58% (7/12) with PSA testing ≥10 ng/ml, among the 97 men who agreed to undergo transrectal ultrasound-guided biopsy (TRUS-guided biopsy). The PSA values showed a statistically significant positive association with diagnosis of PR.CA, whereas T and the T/PSA ratio were inversely and significantly related to the disease. In addition, out of 718 subjects, 45 (2.6%) were found to have a T value <2.6 ng/ml and another 78 (10.8%) had “low normal T value” (2.6≥ T <3.0 ng/ml). Of the hypogonadal men, 16 received testosterone enanthate (depot T; 250 mg/ml oily injection, intramuscularly: i.m.; TRT) and three had PSA levels >3.0 ng/ml post-TRT; one was eventually diagnosed with PR.CA. An empirically-determined cut-off of the T/PSA ratio [>95 (“negative”) or ≤0.95 (“positive”)] was found to be optimal with regard to both sensitivity/specificity. This test was “positive” among 95.5% of the PR.CA patients, whereas 81% of biopsies confirmed that non-PR.CA had a “negative” T/PSA ratio, indicating that this ratio can become an adjunct screening test in assessing the risk of PR.CA; in particular, the odds of PR.CA increasing sharply (1/0.08= 12.5 times) with a decrease of the T/PSA ratio by one standard deviation. We conclude that the measurement of the serum T value can become an adjunct test validating further the PSA-weighted risk of PR.CA within the “grey” diagnostic area.