Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA.
J Urol. 2011 Sep;186(3):1005-11. doi: 10.1016/j.juro.2011.04.065. Epub 2011 Jul 23.
We measured prostate specific antigen after 12 months of testosterone replacement therapy in hypogonadal men.
Data were collected from the TRiUS (Testim® Registry in the United States), an observational registry of hypogonadal men on testosterone replacement therapy (849). Participants were Testim naïve, had no prostate cancer and received 5 to 10 gm Testim 1% (testosterone gel) daily.
A total of 451 patients with prostate specific antigen and total testosterone values were divided into group A (197 with total testosterone less than 250 ng/dl) and group B (254 with total testosterone 250 ng/dl or greater). The groups differed significantly in free testosterone and sex hormone-binding globulin, but not in age or prostate specific antigen. In group A but not group B prostate specific antigen correlated significantly with total testosterone (r=0.20, p=0.005), free testosterone (r=0.22, p=0.03) and sex hormone-binding globulin (r=0.59, p=0.002) at baseline. After 12 months of testosterone replacement therapy, increase in total testosterone (mean±SD) was statistically significant in group A (+326±295 ng/dl, p<0.001; final total testosterone 516±28 ng/dl) and group B (+154±217 ng/dl, p<0.001; final total testosterone 513±20 ng/dl). After 12 months of testosterone replacement therapy, increase in prostate specific antigen was statistically significant in group A (+0.19±0.61 ng/ml, p=0.02; final prostate specific antigen 1.26±0.96 ng/ml) but not in group B (+0.28±1.18 ng/ml, p=0.06; final prostate specific antigen 1.55±1.72 ng/ml). The average percent prostate specific antigen increase from baseline was higher in group A (21.9%) than in group B (14.1%). Overall the greatest prostate specific antigen was observed after 1 month of treatment and decreased thereafter.
Patients with baseline total testosterone less than 250 ng/dl were more likely to have an increased prostate specific antigen after testosterone replacement therapy than those with baseline total testosterone 250 ng/dl or greater, supporting the prostate saturation hypothesis. Clinicians should be aware that severely hypogonadal patients may experience increased prostate specific antigen after testosterone replacement therapy.
我们在接受睾酮替代治疗的低睾酮男性中测量了前列腺特异性抗原 12 个月后的情况。
数据来自 TRiUS（美国 Testim 注册研究），这是一项针对接受睾酮替代治疗的低睾酮男性的观察性注册研究（849 例）。参与者为 Testim 初治患者，无前列腺癌，每日接受 5 至 10 克 1%Testim（睾酮凝胶）。
共有 451 例前列腺特异性抗原和总睾酮值患者分为 A 组（197 例总睾酮<250ng/dl）和 B 组（254 例总睾酮 250ng/dl 或更高）。两组在游离睾酮和性激素结合球蛋白方面存在显著差异，但在年龄和前列腺特异性抗原方面没有差异。在 A 组，但不在 B 组中，前列腺特异性抗原与总睾酮（r=0.20，p=0.005）、游离睾酮（r=0.22，p=0.03）和性激素结合球蛋白（r=0.59，p=0.002）在基线时呈显著相关。在接受睾酮替代治疗 12 个月后，A 组（+326±295ng/dl，p<0.001；最终总睾酮 516±28ng/dl）和 B 组（+154±217ng/dl，p<0.001；最终总睾酮 513±20ng/dl）的总睾酮增加具有统计学意义。在接受睾酮替代治疗 12 个月后，A 组（+0.19±0.61ng/ml，p=0.02；最终前列腺特异性抗原 1.26±0.96ng/ml）前列腺特异性抗原增加具有统计学意义，但 B 组（+0.28±1.18ng/ml，p=0.06；最终前列腺特异性抗原 1.55±1.72ng/ml）无统计学意义。A 组的前列腺特异性抗原平均百分比增加（21.9%）高于 B 组（14.1%）。总体而言，治疗后 1 个月观察到的前列腺特异性抗原最大，此后逐渐下降。
与基线总睾酮水平 250ng/dl 或更高的患者相比，基线总睾酮水平<250ng/dl 的患者在接受睾酮替代治疗后更有可能出现前列腺特异性抗原升高，这支持了前列腺饱和假说。临床医生应该意识到，严重的低睾酮患者在接受睾酮替代治疗后可能会出现前列腺特异性抗原升高。
