Login to Access Video or Poster Abstract: MP91-09
Sources of Funding: None

Introduction

PSA secretion is a testosterone (T) dependent process. There is published data suggesting that low serum total T level is an independent predictor of higher stage, higher grade prostate cancer. However, the link between men diagnosed with prostate cancer with low PSA values and T deficiency (TD) has not been explored before.

Methods

All men diagnosed with prostate cancer since 2000 that had a record of pre-treatment early morning total T level measurement were included in the analysis. We analyzed demographic, clinical and pathological data. Patients were stratified according to pre-treatment PSA levels: 0-2; 2.1-4; >4 ng/ml. TD was defined as total T < 300 ng/dL. We evaluated the relationship between these PSA groups and TD. Age, diabetes, and hyperlipidemia were also included in both univariate and multivariable analyses.

Results

Mean age of 349 men was 64±8 years. The distribution by PSA group was: 5% 0-2, 16% 2.1-4, and 79% >4. The mean T level across the entire cohort was 358±192 ng/dl. Overall, 38% had a T level < 300 ng/dl; 63% > 300 ng/dl. 9% had diabetes, 10% had hyperlipidemia. The mean T leve by PSA group was: 265±168 0-2; 328±210 2.1-4; and 371±189 >4, p=0.03. The percentage of men with TD by PSA group was: 53% 0-2; 49% 2.1-4; and 35% >4, p=0.05. The percentage of men with extremely low T levels (<200) by PSA group was: 35% 0-2; 22% 2.1-4; and 13% >4, p=0.01. Age, diabetes, and hyperlipidemia were not related to T level grouping on univariate analyses (p=0.35 to p=0.81). On multivariable analysis, PSA 0-2 compared to PSA >4: OR=2.1, 95% CI: 0.82-5.36, p=0.12; PSA 2.1-4 compared to PSA >4: OR=1.9, 95% CI: 1.02-3.34, p=0.04. PSA 0-2 compared to PSA >4 was not significant due to low sample size.

Conclusions

Low PSA levels predict TD in a cohort of patients with prostate cancer. This finding suggests a possible benefit of adding total T level measurement when a patient with low PSA is diagnosed with prostate cancer.

Funding

None