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.

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.