Is serum PSA a predictor of male hypogonadism? Testing the hypothesis

ABSTRACT Objective: Male hypogonadism (MH) is common among infertile men. Besides testosterone, limited MH biomarkers are available, while researchers have suggested the use of prostate-specific antigen (PSA) to help diagnose MH. Hence, we sought to evaluate the potential use of PSA to predict MH among relatively young men with infertility in Nigeria. Materials and methods: The study included 707 male partners (35-44 years) in infertile couples seeking infertility evaluation at a third-level care center in Nigeria. MH was diagnosed using standard guidelines. Receiver operating characteristic (ROC) and regression analyses explored the potential of serum free PSA (fPSA) and total PSA (tPSA) in predicting MH and MH-related clinical features. Results: In all, 29.7% of the patients had MH (MH+ve). The MH+ve group had lower mean values of fPSA and tPSA than the group without MH (MH-ve). The best fPSA threshold of < 0.25 μg/L compared with the best tPSA threshold of < 0.74 μg/L had higher accuracy (area under the curve [AUC] 0.908 versus 0.866, respectively), sensitivity (87% versus 83%, respectively), and specificity (42% versus 37%, respectively) for MH diagnosis. After adjustment for confounders, fPSA level ≤ 0.25 μg/L was more likely to predict MH-related decreased libido (odds ratio [OR] 2.728, p<0.001) and erectile dysfunction (OR 3.925, p<0.001) compared with tPSA ≤ 0.74 μg/L in the MH+ve group. Conclusion: For MH diagnosis, fPSA and tPSA had good sensitivity but very poor specificity, although fPSA had better potential for MH diagnosis and association with MH-related clinical features than tPSA. Hence, fPSA could complement other biomarkers for MH diagnosis in men 35-44 years, although we recommend further studies to confirm these findings.

Is serum PSA a predictor of male hypogonadism? Testing the hypothesis.

OBJECTIVE: Male hypogonadism (MH) is common among infertile men. Besides testosterone, limited MH biomarkers are available, while researchers have suggested the use of prostate-specific antigen (PSA) to help diagnose MH. Hence, we sought to evaluate the potential use of PSA to predict MH among relatively young men with infertility in Nigeria. METHODS: The study included 707 male partners (35-44 years) in infertile couples seeking infertility evaluation at a third-level care center in Nigeria. MH was diagnosed using standard guidelines. Receiver operating characteristic (ROC) and regression analyses explored the potential of serum free PSA (fPSA) and total PSA (tPSA) in predicting MH and MH-related clinical features. RESULTS: In all, 29.7% of the patients had MH (MH+ve). The MH+ve group had lower mean values of fPSA and tPSA than the group without MH (MH-ve). The best fPSA threshold of < 0.25 µg/L compared with the best tPSA threshold of < 0.74 µg/L had higher accuracy (area under the curve [AUC] 0.908 versus 0.866, respectively), sensitivity (87% versus 83%, respectively), and specificity (42% versus 37%, respectively) for MH diagnosis. After adjustment for confounders, fPSA level ≤ 0.25 µg/L was more likely to predict MH-related decreased libido (odds ratio [OR] 2.728, p<0.001) and erectile dysfunction (OR 3.925, p<0.001) compared with tPSA ≤ 0.74 µg/L in the MH+ve group. CONCLUSION: For MH diagnosis, fPSA and tPSA had good sensitivity but very poor specificity, although fPSA had better potential for MH diagnosis and association with MH-related clinical features than tPSA. Hence, fPSA could complement other biomarkers for MH diagnosis in men 35-44 years, although we recommend further studies to confirm these findings.

Status of Serum Prolactin Levels among Male Cohort in Infertile Couples.

BACKGROUND: Abnormalities of serum prolactin adversely impact the reproductive functions among infertile men. Hence, this study was aimed to determine the influence of prolactin abnormalities on gonadal functions of male cohorts of infertile unions in Port Harcourt, Nigeria. METHODS: This was a retrospective survey of 1845 males of infertile unions who presented in a health-care facility for reproductive endocrine evaluation following abnormal semen parameters between 2007 and 2018. The demographic, clinical, and laboratory variables were evaluated among study cohorts. RESULTS: Hyperprolactinemia was observed in 16.7% of the study cohorts with 9.6%, 5.0%, and 2.1% of mild, moderate, and severe grades, respectively. The hyperprolactinemic cohorts had depressed levels of follicle-stimulating hormone (FSH), luteinizing hormones (LH), and total testosterone (TT) which worsened further with worsening grades of hyperprolactinemia. Inverse relationship of prolactin levels existed with FSH (crude ß: -0.651; P < 0.001; adjusted ß: -0.666; P < 0.001), LH (crude ß: -0.481; P < 0.001; adjusted ß: -0.536; P < 0.001), and TT (crude ß: -0.525; P < 0.001; adjusted ß: -0.546; P < 0.001) in crude analysis and amplified on age and body mass index (BMI) adjustment. The greatest risk of depressive impact of hyperprolactinemia was on serum TT (crude hazard ratio [HR]: 35.185; P < 0.001; age and BMI-adjusted HR: 35.086; P < 0.001). Erectile dysfunction (ED) was the single most isolated sexual abnormality (n = 111; 35.6%) recorded among the general hyperprolactinemics; however, the ED was specifically more prevalent (n = 15; 38.5%) among the severely hyperprolactinemics. CONCLUSION: The present study revealed a high frequency of hyperprolactinemia among studied participants. Since the hyperprolactinemia was associated with a large number of cases with other endocrine and sexual dysfunctions, diagnostic and treatment protocols should include prolactin measurement and management during infertility evaluation in males.

The Prevalence of Zinc Deficiency among Men with and without Prostate Cancer in Port Harcourt, Nigeria.

Background: Zinc deficiency is reportedly common and influences prostate cancer (PCa) incidence among elderly males. Hence, this study was designed to determine the prevalence of zinc deficiency among Nigerian males with PCa.Materials and Methods: This was a descriptive case-control study among 220 PCa patients and 220 age-matched controls. Clinical and laboratory variables were obtained and evaluated among both study groups. Analysis of serum PSA and plasma zinc was done under standard protocols.Results: No age difference (cases: 69.73 ± 7.72 vs controls: 68.97 ± 7.32; P > 0.05) was observed among both study groups. Prevalence of zinc deficiency among PCa and control groups was 69.1% and 21.8%, respectively. Zinc deficiency was more prevalent among the elderly PCa patients (n = 119; 78.3%) compared to elderly controls. Higher proportion (n = 136; 89.5%) of zinc-deficient PCa patients presented with moderate-severe PCa disease. Elderly PCa patients (n = 119; 81.0%) predominated among those exhibiting moderate-severe PCa disease. Inverse relationship between zinc and age was more pronounced among the PCa patients (Beta= -0.454; P < 0.001) than the controls (Beta= -0.343; P ≤ 0.001).Conclusion: The study findings indicate a significant burden of zinc deficiency associated with adverse outcome of PCa among elderly males with the disease. Zinc deficiency may serve as a therapeutic target or diagnostic marker in elderly males with PCa.

The impact of plasma zinc status on the severity of prostate cancer disease.

Purpose: The severity of prostate cancer (PCa), which determines the disease progression, is theorized to be a function of zinc status. Hence, this study was structured to determine the impact of zinc status on the severity and progression of PCa disease. Materials and Methods: This was a descriptive cross-sectional study of 220 histologically-confirmed PCa patients and 220 age-matched controls, conducted prospectively in a Nigerian tertiary hospital. Plasma zinc, prostate-specific antigen, creatinine, fasting glucose, and estimated glomerular filtration rate were determined for both study groups. The International Society of Urological Pathology (ISUP) grades and the American Joint Committee on Cancer clinical staging were employed as indices for PCa severity (grade) and progression (stage) respectively. Results: The PCa patients had markedly reduced plasma zinc status compared to controls (cases: 9.42±3.02 µmol/L versus controls: 15.23±4.47 µmol/L; p<0.001). Low zinc status was more pronounced within the severe grade and advanced PCa disease subgroups (p<0.001). Inverse relationships existed between zinc status and ISUP grades among the entire PCa patient (p<0.001) and the categorized PCa grade and stage subgroups (p<0.001). Low zinc status had significant impact of predicting severe (crude=odds ratio [OR], 8.714; p<0.001; age-adjusted=OR, 11.152; p<0.001) and advanced (crude=OR, 17.160; p<0.001; age-adjusted=OR, 18.927; p<0.001) PCa disease. Conclusions: This study suggests that low plasma zinc status is associated with severe grade and advanced PCa disease. However, further well-designed studies with large sample sizes are warranted to confirm these associations.