Prostate-Specific Antigen Concentrations in Response to Testosterone Treatment of Severely Hypogonadal Men

Abstract

Context Clinical guidelines recommend measurement of the serum prostate specific antigen (PSA) concentration during testosterone treatment of hypogonadal men to determine if the increase is sufficiently high to warrant urologic referral. Prior studies of the effect of testosterone treatment on PSA concentrations have been conducted in men who were mildly to moderately hypogonadal. Objective To determine the PSA response to testosterone treatment of men who are severely hypogonadal. Design Retrospective cohort study. Setting Single academic medical center. Participants Eighty-five men who were severely hypogonadal due to hypothalamic-pituitary or testicular disease. Main Outcome Measure Changes in serum PSA concentrations during testosterone treatment for up to 18 months. Results Testosterone treatment increased the median serum testosterone concentration from 36 ng/dL (IQR 20-91 ng/dL) at baseline to 395 ng/dL (IQR 266-542 ng/dL) at 6-18 months. This treatment resulted in a median increment in PSA above baseline of 0.70 ng/mL (IQR 0.10-1.85 ng/mL) at 6-18 months. Apropos current Endocrine Society clinical guidelines, 31% of the men experienced a PSA increase above baseline >1.4 ng/mL, and 13% reached an absolute PSA concentration >4.0 ng/mL. Four men were diagnosed with prostate cancer. Conclusions The PSA response to testosterone replacement in men who are severely hypogonadal due to pituitary or testicular disease is greater than that previously reported in men with mild to moderate hypogonadism. These results suggest that the magnitude of the PSA response to testosterone replacement is related to the degree of hypogonadism.

The Effect of a Combination of Eucommia ulmoides and Achyranthes japonica on Alleviation of Testosterone Deficiency in Aged Rat Models

“…Patients can undergo testosterone replacement therapy to increase their testosterone levels. However, this can also lead to increased PSA levels, which are associated with prostate cancer; therefore, periodic monitoring is required [24]. There were no significant differences in serum PSA levels between the groups with or without administration of EUAJ (3:1).…”

A case of hyperprolactinaemia in a patient with metastatic melanoma

“…Ectopic prolactin secretion has been reported in the literature from a variety of extra-pituitary solid tumours, including ovarian tumours [7][8][9], uterine carcinomas [10,11], non-Hodgkin's lymphoma [12], perivascular epithelioid tumours [13], colorectal adenocarcinoma [14], lung cancer [15], renal cell cancer [15,16] and sphenoid sinus pituitary adenomas [17]. However, to our knowledge, there have been no previous reports of ectopic prolactin secretion from metastatic melanoma.…”

“…Prolactin staining cells have been identified in the skin involved in dermatological bioregulation and so theoretically is it possible that a metastatic melanoma has the ability to produce prolactin [18]. While some cases have reported positive immunohistochemical staining for prolactin [11,13] others, including ourselves, have failed to show this. There are several possible explanations for this finding.…”