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Endocrine Abstracts (2013) 32 P658 | DOI: 10.1530/endoabs.32.P658

1University of Florence, Florence, Italy; 2Maggiore Hospital, Bologna, Italy.

Objective: To verify whether, in a large sample of male subjects seeking medical care for sexual dysfunction (SD), prostate-specific antigen (PSA) might represent a reliable marker of testosterone bioactivity, even downstream to its receptor binding.

Design: Cross-sectional study.

Methods: A consecutive series of 3156 patients attending our Unit for SD studied. Among them, only subjects without history of prostate disease and with PSA levels <4 ng/ml (n=2967) were analyzed. Several clinical and biochemical parameters were studied.

Results: Receiver operating characteristic curve analysis for predicting severe hypogonadism (T<8 nmol/l) showed an accuracy of PSA=0.612±0.022 (P<0.0001), with the best sensitivity and specificity at PSA <0.65 ng/ml (65.2 and 55.5% respectively). After adjusting for age, low PSA was associated with higher prevalence of hypogonadism-related clinical features, (i.e. delayed puberty, lower testis volume), and associated conditions, as metabolic syndrome (HR=1.506 (1.241–1.827); P<0.0001), type 2 diabetes (HR=2.044 (1.675–2.494); P<0.0001) and cardiovascular diseases (HR=1.275 (1.006–1.617); P=0.045). Furthermore, low PSA was more frequently associated with sexual symptoms, such as impaired sex- and sleep-related erections. The association between low PSA and hypogonadal symptoms and signs as well as with metabolic syndrome was retained even after adjusting for T levels.

Conclusions: PSA is a reliable marker of T biological activity and it may represent a new tool in detecting clinically relevant hypogonadism. The single, costless determination of PSA levels might give insights not only on the circulating levels of total T, but also on its active fractions and, most importantly, in androgen receptor bioactivity.

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