Sofikerim Mustafa, Eskicorapci Sadettin, Oruç Ozgur, Ozen Haluk
Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
Urol Int. 2007;79(1):13-8. doi: 10.1159/000102906.
Androgens are necessary for the development and functioning of the prostate gland. The association of serum testosterone and pituitary hormone levels with prostate cancer development is not completely understood. In this clinical study, we evaluated the role of serum testosterone, free testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in predicting prostate cancer risk in patients who had transrectal ultrasonography-guided prostate biopsy with the suspicion of prostate cancer.
A total of 211 patients who were selected to undergo prostatic biopsy due to abnormal digital rectal examination and/or a serum prostate-specific antigen (PSA) level >2.5 ng/ml were included in the study. The patient characteristics of total PSA, free/total PSA ratio, serum total testosterone, free testosterone, free/total testosterone ratio, FSH and LH levels were compared according to the pathological diagnosis.
The mean age was 63.91 years (range 44-83) and the mean PSA level was 9.23 ng/ml (range 0.13-50.41) in the whole group. Of 211 patients, 69 (32.7%) were positive for prostate cancer. The patients who were positive for prostate cancer had statistically lower levels of serum total testosterone compared with the patients who were diagnosed as having benign prostatic hyperplasia (BPH; 405 vs. 450.5 ng/dl, respectively; p = 0.013). The serum FSH level was significantly higher in men with prostatic cancer than in men with BPH (7.56 vs. 6.06 mIU/ml, respectively; p = 0.029). No significant differences between men with prostatic cancer and those with BPH were found for serum LH levels. When normal ranges for serum free and total testosterone levels were defined as 9 pg/ml and 300 ng/dl, respectively, patients who had low free testosterone and total testosterone levels had significantly higher cancer detection rates than patients with high serum androgen levels: 40.8% (40/98) versus 25.6% (29/113) (p = 0.021), and 48.6% (18/37) versus 29.3% (51/174), respectively (p = 0.023). After logistic regression analysis, none of the hormones showed a significant difference in predicting the risk of prostate cancer in patients undergoing prostate biopsy with suspicion of the disease.
Our data suggest that patients diagnosed with prostate cancer have low levels of serum testosterone and high levels of serum FSH compared with the patients with BPH. No support was found for the theory that high levels of testosterone increase prostate cancer risk. Further studies are needed to clarify the relationship between hormones and prostate cancer etiology.
雄激素对于前列腺的发育和功能至关重要。血清睾酮和垂体激素水平与前列腺癌发生之间的关联尚未完全明确。在这项临床研究中，我们评估了血清睾酮、游离睾酮、黄体生成素（LH）和卵泡刺激素（FSH）水平在怀疑患有前列腺癌且接受经直肠超声引导下前列腺活检的患者中预测前列腺癌风险的作用。
本研究纳入了总共211例因直肠指检异常和/或血清前列腺特异性抗原（PSA）水平>2.5 ng/ml而被选进行前列腺活检的患者。根据病理诊断比较了总PSA、游离/总PSA比值、血清总睾酮、游离睾酮、游离/总睾酮比值、FSH和LH水平的患者特征。
全组患者的平均年龄为63.91岁（范围44 - 83岁），平均PSA水平为9.23 ng/ml（范围0.13 - 50.41）。在211例患者中，69例（32.7%）前列腺癌呈阳性。与被诊断为良性前列腺增生（BPH）的患者相比，前列腺癌呈阳性的患者血清总睾酮水平在统计学上较低（分别为405 ng/dl和450.5 ng/dl；p = 0.013）。前列腺癌男性患者的血清FSH水平显著高于BPH男性患者（分别为7.56 mIU/ml和6.06 mIU/ml；p = 0.029）。前列腺癌男性患者与BPH男性患者的血清LH水平未发现显著差异。当将血清游离睾酮和总睾酮水平的正常范围分别定义为9 pg/ml和300 ng/dl时，游离睾酮和总睾酮水平低的患者的癌症检出率显著高于血清雄激素水平高的患者：分别为40.8%（40/98）对25.6%（29/113）（p = 0.021），以及48.6%（18/37）对29.3%（51/174）（p = 0.023）。经过逻辑回归分析，在怀疑患有该疾病而接受前列腺活检的患者中，没有一种激素在预测前列腺癌风险方面显示出显著差异。
我们的数据表明，与BPH患者相比，被诊断为前列腺癌的患者血清睾酮水平较低，血清FSH水平较高。未发现睾酮水平升高会增加前列腺癌风险这一理论的支持证据。需要进一步研究来阐明激素与前列腺癌病因之间的关系。
