Circulating total testosterone and PSA concentrations in a nationally representative sample of men without a diagnosis of prostate cancer

Abstract

Background The association between serum sex steroid hormones and PSA in a general population has not been described. Methods Included were 378 men aged 40-85 years who participated in the National Health and Nutrition Examination Survey in 2001-2004, who did not have a prostate cancer diagnosis, and had not had a recent biopsy, rectal examination, cystoscopy, or prostate infection or inflammation. Serum total PSA, total testosterone, androstanediol glucuronide (3α-diol-G), estradiol, and sex hormone binding globulin (SHBG) concentrations were previously measured. Free testosterone was estimated by mass action. We applied sampling weights and calculated geometric mean PSA concentration by hormone quintiles adjusting for age and race/ethnicity, and also for body mass index, waist circumference, smoking, diabetes, and mutually for hormones. We estimated the OR of PSA ≥2.5 ng/mL per hormone quintile using logistic regression. Results Geometric mean PSA increased across testosterone quintiles after age and race/ethnicity (Q1: 0.80, Q5: 1.14 ng/mL; P-trend=0.002) and multivariable (Q1: 0.79, Q5: 1.16 ng/mL; P-trend=0.02) adjustment; patterns were similar for free testosterone and 3α-diol-G. SHBG was inversely associated with PSA only after multivariable adjustment (Q1: 1.32, Q5: 0.82 nmol/L; P-trend=0.01). Estradiol and PSA were not associated. The OR of PSA ≥2.5 ng/mL was 1.54 (95% CI 1.18-2.01) per testosterone quintile after age and race/ethnicity adjustment, and 1.78 (95% CI 1.16-2.73) after multivariable adjustment. Conclusions In this nationally representative sample, men with higher testosterone had higher PSA even after taking into account other hormones and modifiable factors. Men with higher SHBG had lower PSA, but only after multivariable adjustment.

Association between serum 25‐hydroxyvitamin D and serum sex steroid hormones among men in NHANES

“…If vitamin D is linked with higher PSA, which prompts prostate biopsies, then vitamin D would appear to be positively associated with prostate cancer risk without a causal influence on prostate cancer aetiology. The association between sex steroid hormones and PSA concentration (including a positive association between testosterone and PSA concentration) in continuous NHANES has been reported previously …”

“…The association between sex steroid hormones and PSA concentration (including a positive association between testosterone and PSA concentration) in continuous NHANES has been reported previously. 17…”

Comparison of the Effects of Testosterone Gels, Injections, and Pellets on Serum Hormones, Erythrocytosis, Lipids, and Prostate-Specific Antigen

“…However, small increases in PSA levels in men initiating TTh during the first few months following therapy initiation have been observed [29]. Furthermore, a recent study observed overall higher PSA levels in men on T [25]. However, these increases in PSA levels are not related to the risk of CaP, and support the stimulation of prostate tissue containing unsaturated androgen receptors, as described in the prostate saturation theory proposed by Morgentaler [26].…”

Association between Basal Total Testosterone Levels and Tumor Upgrading in Low and Intermediate Risk Prostate Cancer

“…As a result, low volume and low grade cancers associate with lower median levels of TT and PSA as well as high volume and high grade cancers associate with increased median levels of TT and PSA. The positive association between TT and PSA has also been demonstrated in men who did not have a diagnosis of PCA; indeed, men with higher testosterone had higher PSA [21] . Our upgrading risk model relates to the pathophysiology of the disease along the pituitary-testis-prostate axis and supports the positive functional relation between TT and PSA levels in PCA patients.…”