The relationship of testosterone to PSA in men with sexual dysfunction
Giovanni Corona1,3, Valentina Boddi1, Francesco Lotti1, Mauro Gacci2, Marco Carini2, Giulia De Vita1, Alessandra Sforza3, Gianni Forti1, Edoardo Mannucci4 & Mario Maggi1
Introduction: Concern about a testosterone-induced PSA increase is often perceived as one of the main limitations in treating hypogonadism even when it is symptomatic, such as in subjects with sexual dysfunction (SD). The aim of the present study is to evaluate the relationship between testosterone (T) and PSA levels in subjects with SD.
Methods: We retrospectively evaluated the relationship between T and PSA in 2291 subjects seeking medical care at our Outpatient Clinic for SD (Sample A). The analysis was then repeated in a selected subpopulation of 1421 subjects apparently free from prostatic diseases (Sample B). The specific association between PSA levels, circulating androgens and different clinical signs and symptoms of hypogonadism, as assessed by ANDROTEST structured interview, was evaluated.
Results: In both Sample A and B, subjects with higher PSA levels reported a lower prevalence of hypogonadism related symptoms and signs, as well as higher total T, analogue and calculated free-T. However, when the association between PSA and T was evaluated as a function of T deciles, the upper 9 groups had similar PSA values, with the lowest demonstrated a significantly reduced PSA (the lowest vs. the rest of the sample: 0.61[0.381.23] ng/ml vs 0.86[0.571.44] ng/ml and 0.51[0.300.94] ng/ml vs 0.73[0.521.10] ng/ml, respectively for Sample A and B; both P<0.0001). Furthermore, when the relationship between hypogonadism (total T<8 nmol/l) and PSA levels was evaluated according to age, it was significant only in younger subjects, but not in the older ones.
Conclusions: Our data demonstrated PSA is unrelated to T concentration across most of the T range, except for the most severely T-deficient, and that a significant relationship between T and PSA is seen in younger but not older men.