Prostatic Specific Antigen in Patients with Hypogonadism: Effect of Testosterone Replacement

Abstract

Introduction The effect of parenteral testosterone replacement therapy on prostatic specific antigen (PSA) level or the development or growth of prostate cancer is unclear. Aim To assess the effect of testosterone replacement on PSA level in patients with hypogonadism associated with erectile dysfunction (ED). Methods A total of 187 male patients above the age of 45 with hypogonadism associated with ED were enrolled in this study. Patients were screened for ED by the erectile function domain of the International Index of Erectile Function (IIEF). Patients underwent routine laboratory investigations, plus total testosterone, and PSA assessment. Replacement treatment with parenteral testosterone every 2–4 weeks for 1 year was instituted. Total testosterone and PSA serum levels were assessed every 3 months during the treatment course. Results Mean age ± SD was 62.8 ± 11.4. Of the patients 87.7% were sexually active. Of the patients 10.2% had mild, 40.6% had moderate and 49.2% had severe ED. Of the study population, 62.5% had ED complaints for less than 5 years and 84.5% had gradual onset of their complaint. The majority of the patients (91.4%) had either progressive or stationary course while the minority reported regressive course and improvement of the condition. There was a significant increase of the post-treatment testosterone level in comparison to pretreatment level (P < 0.05). No significant increase in the post-treatment PSA level in comparison to pretreatment (P > 0.05). No significant difference between pre- and post-treatment categories of PSA level (normal, borderline, high) in relation to the severity of ED (P > 0.05). There was no significant association between PSA level and the duration of testosterone replacement therapy in the study population (P > 0.05). Conclusion The current study demonstrated that the level of PSA was not significantly changed after 1 year of testosterone replacement therapy in patients with hypogonadism associated with ED.

The benefits and risks of testosterone replacement therapy: a review

“…283,284 Men successfully treated for prostate cancer and diagnosed with hypogonadism are candidates for testosterone replacement after a prudent interval if there is no clinical or laboratory evidence of residual cancer. 285,286 In addition, no effect was found of testosterone replacement therapy on PSA levels [287][288][289] and the change in PSA were not influenced by the mode of testosterone replacement therapy, patient age, or baseline levels of PSA or testosterone. 290 The online prostate cancer risk calculator is one of the most commonly used tools to assist the clinician in assessing the risk of prostate cancer.…”

Testosterone therapy in hypogonadal men and potential prostate cancer risk: a systematic review

“…All of the men met inclusion criteria, with a PSA level o4.0 ng ml À1 before treatment, normal results on DRE, or a pretreatment prostate biopsy negative for cancer for men with an abnormal DRE or an elevated PSA level. PSA levels increased, but no cancers were detected in the El-Sakka et al 41 1-year study of patients with hypogonadism associated with erectile dysfunction. Douglas et al…”

Is there a Clinically Useful Relationship between Testosterone and Prostate Specific Antigen in Patients with Lower Urinary Tract Symptoms?

“…Based on a study of 65 men Gustafsson et al also observed that there was no relationship between PSA and Testosterone [7]. El-Sakka AI et al in 2005 studied the effect of Testosterone replacement on PSA level in 187 hypogonadal men for one year [8]. There was no significant association found between PSA level and the duration of Testosterone replacement therapy in their study population.…”