Testosterone-corrected PSA density may enhance PCa prediction

May 23, 2005

Findings from a retrospective analysis of men presenting for prostate biopsy because of elevated PSA indicate that an appreciable subset of this population is hypogonadal and suggest those men undergo biopsy at a relatively lower PSA cut-off relative to eugonadal men. Thus, correcting PSA density (PSAD) based on serum testosterone level may improve specificity for cancer detection in men with elevated PSA.

Findings from a retrospective analysis of men presenting for prostate biopsy because of elevated PSA indicate that an appreciable subset of this population is hypogonadal and suggest those men undergo biopsy at a relatively lower PSA cut-off relative to eugonadal men. Thus, correcting PSA density (PSAD) based on serum testosterone level may improve specificity for cancer detection in men with elevated PSA.

"These are general recommendations based on preliminary analyses. A much larger study would be needed to determine the true sensitivity and specificity of a testosterone-corrected PSA parameter and whether it is better than PSA alone," Samin S. Taneja, MD, associate professor of urology and director of urologic oncology at the New York University School of Medicine and NYU Cancer Institute, told Urology Times.

Dr. Taneja and colleagues undertook a retrospective study to determine whether correcting serum PSA for serum testosterone (T) might improve the ability of PSA to predict prostate cancer, recognizing that androgen stimulation is necessary for PSA gene transcription and that it affects prostate volume. The study included data from 191 consecutive men who presented for prostate biopsy and who had frozen serum samples collected prospectively in an IRB-approved serum bank. Of them, 26.2% were found to have prostate cancer and 20.9% were identified as hypogonadal, defined by a total serum testosterone (T)

Relative to their hypogonadal counterparts, the eugonadal men had:

  • a higher rate of prostate cancer (32.5% vs. 24.5%)

  • a significantly larger mean prostate volume (57.1 cc vs. 43.8 cc)

  • similar PSA, PSA density (PSAD), complexed PSA (cPSA), and cPSAD values

However, T-corrected PSAD [PSA/(prostate volume x serum T)] was significantly higher among the hypogonadal men than those with normal serum T (pp