Serum complexed and free prostate-specific antigen (PSA) for the diagnosis of the polycystic ovarian syndrome (PCOS)

Abstract

Background Polycystic ovarian syndrome (PCOS) is a common cause of reproductive and metabolic dysfunction. We hypothesized that serum prostate specific antigen (PSA) may constitute a new biomarker for hyperandrogenism in PCOS. Method We conducted a cross-sectional study of 45 women with PCOS and 40 controls. Serum from these women was analyzed for androgenic steroids and for complexed PSA (cPSA) and free PSA (fPSA) with a novel fifth generation assay with a sensitivity of ~10 fg/mL for cPSA and 140 fg/mL for fPSA. Results cPSA and fPSA levels were about 3 times higher in PCOS compared to controls. However, in PCOS, cPSA and fPSA did not differ according to hip-to-waist ratio, Ferriman-Gallwey score, or degree of hyperandrogenemia or oligo-ovulation. In PCOS and control women, serum cPSA and fPSA levels were highly correlated with each other, and with free and total testosterone levels, but not with other hormones. Adjusting for age, body mass index (BMI) and race, cPSA was significantly associated with PCOS, with an odds ratio (OR) of 5.67 (95% CI: 1.86, 22.0). The OR of PCOS for fPSA was 7.04 (95% CI: 1.65, 40.4). A multivariate model that included age, BMI, race and cPSA yielded an area-under-the-receiver-operating-characteristic (AUC-ROC) curve of 0.89. Conclusions Serum complexed PSA and free PSA are novel biomarkers for hyperandrogenism in PCOS and may have value for disease diagnosis.

Serum complexed and free prostate specific antigen levels are lower in female elite athletes in comparison to control women

“…These assays can quantify both complexed and free PSA in serum and urine of females and allow examination of the possible role of female PSA in healthy and disease states. We recently confirmed the diagnostic value of cPSA and fPSA in women with PCOS by using one of these assays 32 .…”

“…We have recently shown that median cPSA concentration in normal women is around 900 fg/mL, while fPSA is about ten times lower (70 fg/mL). In women with PCOS, serum PSA concentration is elevated by about 3-fold 32 .…”

Serum Prostate-Specific Antigen Level in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis

“…The use of newer and more precise methods, such as the fourth-generation of nucleic acid detection immunoassay (NADiA) test with accuracy of ≤ 1 pg/ml [71] and the fifth generation (SiMoA), a paramagnetic bead-based ELISA that is able to measure very low PSA levels even 0.1 pg/ml [72], provides more accurate results. Diamandis et al showed that the fifth generation technique could even distinguish cPSA and fPSA values in women [18]. Unfortunately, we did not include this study into our meta-analysis due to not reporting the level of total PSA.…”

“…It seems that PSA secretion is affected by steroid hormones [16] and its level in the urine and serum of women with hyperandrogenism and PCOS is significantly higher than healthy people. Therefore, various studies investigated the diagnostic value of the PSA in the diagnosis of PCOS [17][18][19]; however, the results are inconclusive and controversial. On the other hand, the diagnosis of hyperandrogenism in women is associated with some problems.…”

Effect of age on serum prostate-specific antigen in women

“…These data are important because female serum PSA is now measureable by highly sensitive assays and could have value as a biomarker in cancer or other diseases such as polycystic ovarian syndrome or be useful in testing for female athlete doping [5,6]. Serum PSA data in women should be interpreted with caution because of the significant decrease of values with patient age, which is opposite to the trend in males.…”