Additional value of the ratio of serum total testosterone to total prostate-specific antigen in the diagnosis of prostate cancer in a Chinese population

Xu, Lei; Hu, Xueqin; Zhu, Yao; Lu, Jinjin; Xu, Yang; Wang, G.; Guo, Jianming

doi:10.1111/and.12872

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…Postoperative PSA changes in BPH patients have also been reported, but mainly in TURP studies, and HoLEP studies remain few in comparison. The findings in our study are aligned with previous studies in that elevated PSA levels showed correlations with AUR, BOO, and prostate volume [11]. Patients with larger prostates have been reported in the literature to show higher PSA levels before HoLEP and had a significantly greater decrease after surgery [21].…”

Section: Discussionsupporting

confidence: 92%

“…P-Bx was considered when the PSA level was high ( ≥3.0 ng/mL), when a digital rectal exam showed suspicious findings, and/or when imaging showed abnormal findings [10]. For patients taking 5-alpha reductase inhibitors (5-ARIs), the PSA value was multiplied by 2 [11], and this doubled value was used to determine whether to perform a P-Bx. At our institution, until 2017, 12-core biopsies were conducted near the base, midgland, and apex.…”

Section: Methodsmentioning

confidence: 99%

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Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

et al. 2022

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Purpose: This study investigated functional outcomes in lower urinary tract symptoms (LUTS), the incidence of incidental prostate cancer (PCa), and changes in prostate-specific antigen (PSA) levels after holmium laser enucleation of the prostate (HoLEP) in patients with elevated PSA and benign prostatic hyperplasia (BPH).Methods: A retrospective review of a prospectively designed protocol for patients who underwent HoLEP at our institution from January 2010 to May 2020 was conducted. Patients were classified into low-PSA (<3.0 ng/mL) and high-PSA (≥3.0 ng/mL) groups at baseline. Follow-up for PSA was performed at the sixth postoperative month. Baseline and postoperative clinical parameters, functional parameters, PCa incidence, and postoperative changes in PSA were compared between the lowand high-PSA groups.Results: The baseline PSA of 1,296 patients (mean age, 69.7±6.8 years) was 4.0±4.1 ng/mL, with 712 patients (55.0%) in the low-PSA group (1.6±0.8 ng/mL), and 584 patients (45.0%) in the high-PSA group (6.9±4.7 ng/mL). Incidental PCa was detected in 82 patients (6.3%), with a similar incidence in the low-PSA (41 patients, 5.9%) and high-PSA (41 patients, 7.0%) groups (P>0.05). At 6 months postoperatively, both groups showed significant improvements in the maximum flow rate, postvoid residual volume, and all domains of the International Prostate Symptom Score (P<0.05). At postoperative 6 months, the PSA level significantly decreased by 66.6%±23.6% in all patients (54.3%±23.9% in the low-PSA group; 79.6%±14.7% in the high-PSA group) (P<0.05), and the PSA levels of 1,264 patients (97.6%) had normalized.Conclusions: In patients with elevated PSA presenting with LUTS/BPH, our study demonstrated significant improvements in functional parameters and decreased PSA after HoLEP. The incidental PCa detection rate did not show a statistically significant difference between the low- and high-PSA groups. Timely surgery for LUTS/BPH without delay due to PSA monitoring should be considered.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

et al. 2022

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“…Prostate cancer detection accuracy has been improved with the use of the PSA/testosterone ratio (Gurbuz et al 2012, Xu et al 2018. In contrast, adjusting only for obesity in addition to PSA did not improve specificity (Oh et al 2013, Banez et al 2014, Vidal et al 2015, Harrison et al 2016).…”

Section: Discussionmentioning

confidence: 99%

The inverse relationship between prostate specific antigen (PSA) and obesity

Aref¹,

Vincent²,

O’Callaghan³

et al. 2018

Endocrine-Related Cancer

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Obese men have lower serum prostate-specific antigen (PSA) than comparably aged lean men, but the underlying mechanism remains unclear. The aim of this study was to determine the effect of obesity on PSA and the potential contributing mechanisms. A cohort of 1195 men aged 35 years and over at recruitment, with demographic, anthropometric (BMI, waist circumference (WC)) and serum hormone (serum testosterone, estradiol (E2)) PSA and hematology assessments obtained over two waves was assessed. Men with a history of prostate cancer or missing PSA were excluded, leaving 970 men for the final analysis. Mixed-effects regressions and mediation analyses adjusting for hormonal and volumetric factors explore the potential mechanisms relating obesity to PSA. After adjusting for age, PSA levels were lower in men with greater WC ( = 0.001). In a multivariable model including WC, age, E2/testosterone and PlasV as predictors, no statistically significant associations were observed between with PSA and either WC ( = 0.36) or PlasV ( = 0.49), while strong associations were observed with both E2/testosterone ( < 0.001) and age ( < 0.001). In the mediation analyses with PlasV as the mediator, the average causal mediation effect (ACME) explained roughly 20% of the total effect of WC on PSA ( = 0.31), while when E2/testosterone is a mediator, the ACME explained roughly 50% of the effect ( < 0.001). Our findings indicate that lower PSA levels in obese men, as compared to normal weight men, can be explained both by hormonal changes (elevated E2/testosterone ratio) and hemodilution. Hormonal factors therefore represent a substantial but underappreciated mediating pathway.

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“…Different from our results, Xu et al compared 92 patients with BPH and 164 patients with PCa from the Chinese population in their study and reported lower TT/tPSA ratios in the PCa group compared to the BPH group. 13 However, they reported that serum TT levels were similar in those 2 groups. Rhoden et al reported a 3-fold increased risk of PCa in patients with a TT/tPSA ratio of less than 1.8.…”

Section: Discussionmentioning

confidence: 94%

“…Therefore, several studies with different outcomes investigated the predictive role of serum testosterone levels and the serum total testosterone (TT)/total PSA (tPSA) ratio on PCa through different methodologies in this population. [9][10][11][12][13][14][15][16] In this study, we have aimed to investigate the adjunctive role of some hematological and biochemical parameters in patients with gray-zone serum PSA levels (2.5-10 ng/mL) for making the differential diagnosis between benign and malignant diseases of the prostate gland prior to prostate biopsy. Furthermore, we have aimed to examine the role of such parameters in predicting the clinically significant PCa grouped according to Epstein criteria.…”

mentioning

confidence: 99%

Adjunctive Role of Some Blood Based Parameters to Serum Prostate Specific Antigen and Its Derivations on Prostate Cancer in Men with ''Gray-Zone'' Prostate Specific Antigen Levels: Prospective Clinical Study

Gül¹,

EKİCİ²,

ZENGİN³

et al. 2022

J Reconstr Urol

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To investigate the adjunctive role of some peripheral blood parameters to serum prostate specific antigen (PSA) in predicting the patients with prostate cancer (PCa) prior to prostate biopsy, and clinically significant PCa among those. Material and Methods: This prospective study included men aged ≥45 years, who were scheduled to undergo a prostate biopsy due to gray-zone PSA levels. The levels of free and total PSA (fPSA and tPSA), total testosterone (TT), PSA density (PSAD), C-reactive protein (CRP), De Ritis ratio (aspartate aminotransferase/alanine transaminase) and hemograms were recorded. Patients were divided into 2 groups as benign prostatic hyperplasia (Group 1) and PCa (Group 2) groups. The PCa group was further divided into 2 subgroups as clinically significant and clinically insignificant PCa. The pre-biopsy values of the variables were compared between the groups. Results: A total of 210 patients were included in the study (Group 1, n=105; Group 2, n=105). The mean age was 65.1±7.4 years, the mean tPSA level was 6.14±2.05 ng/mL, and the mean TT level was 15.46±5.47 nmol/L. Age, prostate volume, the values of fPSA, PSAD, CRP, and the ratios of fPSA/tPSA, CRP/albumin and De Ritis were statistically different between the groups. In the PCa group, only the tPSA level was significantly different between the subgroups (p=0.005). The area under curve and the cut-off value for tPSA to predict clinically significant PCa were 0.669 and 5.8 ng/mL, respectively. Conclusion: CRP, the CRP/albumin ratio and De Ritis ratio may further help predict a diagnosis of PCa.

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Additional value of the ratio of serum total testosterone to total prostate-specific antigen in the diagnosis of prostate cancer in a Chinese population

Cited by 6 publications

References 37 publications

Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

Outcome of Patients With Elevated Prostate-Specific Antigen and Lower Urinary Tract Symptoms Receiving Holmium Laser Enucleation of the Prostate

The inverse relationship between prostate specific antigen (PSA) and obesity

Adjunctive Role of Some Blood Based Parameters to Serum Prostate Specific Antigen and Its Derivations on Prostate Cancer in Men with ''Gray-Zone'' Prostate Specific Antigen Levels: Prospective Clinical Study

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