Elsevier

Urology

Volume 68, Issue 6, December 2006, Pages 1263-1267
Urology

Adult urology
Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less

https://doi.org/10.1016/j.urology.2006.08.1058Get rights and content

Abstract

Objectives

To determine the prevalence of prostate cancer in hypogonadal men with a prostate-specific antigen (PSA) level of 4.0 ng/mL or less.

Methods

A total of 345 consecutive hypogonadal men with a PSA level of 4.0 ng/mL or less underwent evaluation with digital rectal examination and prostate biopsy before initiating a program of testosterone replacement therapy. All men had low serum levels of total or free testosterone, defined as less than 300 and 1.5 ng/dL, respectively.

Results

Cancer was identified in 15.1%. The cancer detection rate was 5.6%, 17.5%, 26.4%, and 36.4% for a PSA level of 1.0 or less, 1.1 to 2.0, 2.1 to 3.0, and 3.1 to 4.0 ng/mL, respectively (P <0.05). Cancer was detected in 26 (30.2%) of 86 men with a PSA level of 2.0 to 4.0 ng/mL. Cancer was detected in 21% of men with a testosterone level of 250 ng/dL or less compared with 12% of men with a testosterone level greater than 250 ng/dL (P = 0.04). Men with free testosterone levels of 1.0 ng/dL or less had a cancer rate of 20% compared with 12% for men with greater values (P = 0.04). The odds ratio of cancer detection for men in the lowest tertile compared with the highest tertile was 2.15 (95% confidence interval 1.01 to 4.55) for total testosterone and 2.26 (95% confidence interval 1.07 to 4.78) for free testosterone.

Conclusions

Prostate cancer was present in more than 1 of 7 hypogonadal men with PSA of 4.0 ng/mL or less. An increased risk of prostate cancer was associated with more severe reductions in testosterone.

Section snippets

Material and methods

From June 1998 to December 2001, 345 consecutive men diagnosed with hypogonadism after referral for sexual dysfunction underwent prostatic evaluation before initiating a program of testosterone replacement therapy. All patients had low levels of total testosterone (TT) or free testosterone (FT), or both, and a PSA level of 4.0 ng/mL or less. Men taking medications known to lower PSA (finasteride or dutasteride) were excluded from this analysis.

The serum determinations of TT and FT were obtained

Results

The characteristics of the study group are shown in Table I. The study included 345 men with a mean age of 58.9 years. Of these, 184 men (53.3%) had a TT level less than 300 ng/dL, and 327 (94.8%) had a FT level of less than 1.5 ng/dL. Of the 345 men, 23 were younger than 50 years, 12 had a TT level of 250 ng/dL or less, and 11 had TT level greater than 250 ng/dL. The PSA level was 4.0 ng/mL or less for all men, and the DRE findings were normal in 70.1%.

The biopsy results revealed 52 patients

Comment

The results of this retrospective study confirm and extend our previous findings that a sizable proportion of hypogonadal men has biopsy-detectable prostate cancer despite normal PSA levels.1 In addition, the combination of low serum testosterone and PSA level greater than 2.0 ng/mL appears to be particularly worrisome for the presence of cancer, because 30.2% of such men in this study had positive biopsy findings. Moreover, this study for the first time presents data showing that lower

Conclusions

This study has revealed that a substantial number of hypogonadal men have biopsy-detectable prostate cancer, even with normal DRE findings and PSA level of 4.0 ng/mL or less. The risk of cancer was doubled for men with the lowest testosterone values and was particularly worrisome when low testosterone levels were combined with PSA levels of 2.0 ng/mL or greater. The relationship between low serum testosterone and prostate cancer risk merits further investigation.

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1

E. L. Rhoden is supported by Coordenação de Aperfeiçoamento Pessoal de Nível Superior of Brazil and is an I-C Reseacher from Conselho Nacional de Pesquisa, Brasil.

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