Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy.
Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy.
J Endocrinol Invest. 2020 Nov;43(11):1599-1606. doi: 10.1007/s40618-020-01243-3. Epub 2020 Apr 4.
Although men with spinal cord injury (SCI) exhibit a prostate volume significantly smaller compared to age-matched able-bodied men, the independent association of lower prostate volume with its putative determinants has never been analyzed in this population. This study was designed to identify variables independently associated with prostate volume in men with chronic SCI.
In this cross-sectional study, prostate volume of 138 men with chronic (> 1 years) SCI, aged 54.5 (25th-75th percentile: 36.0-66.0) years, was evaluated with trans-rectal ultrasonography. All patients underwent a complete neurological exam, as well as biochemical and hormonal assessment, including total testosterone (TT) levels. Free testosterone levels were calculated (cFT) by the Vermeulen formula.
The median prostate volume was 23.4 mL. At the univariate analysis, a larger prostate volume was associated with higher TT (p = 0.00001) and cFT (p = 0.001), SCI level below T12 (p = 0.007), more advanced age (p = 0.04), lower body mass index (p = 0.04), higher functional independence score (p = 0.06), higher values of prostate-specific antigen (p = 0.12) and shorter duration of the injury (p = 0.21). However, at the multiple regression analyses, an independent and positive association only persisted between the prostate volume with either TT or cFT levels, and, to a lesser extent, with age and a level of spinal lesion below T12. A prostate volume below the median value was observed in 91.4% (32/35) of patients with both androgen deficiency (TT < 264 ng/dL) and spinal lesion level ≥ T12, but only in 16.5% (2/12) of patients with both normal androgen levels and spinal lesion level below T12 (p < 0.001).
Our data indicate that lower testosterone levels and, to a lesser extent, a younger age and a spinal lesion level ≥ T12 represent the only variables exhibiting an independent association with a smaller prostate volume in men with SCI.
尽管脊髓损伤（SCI）男性的前列腺体积明显小于同龄健康男性，但前列腺体积与潜在决定因素之间的独立关联从未在该人群中进行过分析。本研究旨在确定与慢性 SCI 男性前列腺体积相关的独立变量。
在这项横断面研究中，通过直肠超声评估了 138 名慢性（>1 年）SCI 男性的前列腺体积，年龄为 54.5（25-75 百分位：36.0-66.0）岁。所有患者均接受了完整的神经检查以及生化和激素评估，包括总睾酮（TT）水平。通过 Vermeulen 公式计算游离睾酮水平（cFT）。
前列腺体积中位数为 23.4mL。在单变量分析中，较大的前列腺体积与较高的 TT（p=0.00001）和 cFT（p=0.001）、T12 以下的 SCI 水平（p=0.007）、较高的年龄（p=0.04）、较低的体重指数（p=0.04）、较高的功能独立性评分（p=0.06）、较高的前列腺特异性抗原值（p=0.12）和较短的损伤持续时间（p=0.21）相关。然而，在多元回归分析中，前列腺体积与 TT 或 cFT 水平之间仅存在独立且正向的关联，并且与年龄和 T12 以下的脊髓损伤水平之间的关联较弱。在 TT<264ng/dL 和脊髓损伤水平≥T12 的 35 名患者中，有 91.4%（32/35）的患者前列腺体积低于中位数，而在 TT 正常和脊髓损伤水平低于 T12 的 12 名患者中，只有 16.5%（2/12）的患者前列腺体积低于中位数（p<0.001）。
我们的数据表明，较低的睾酮水平，以及年龄较小和 T12 以上的脊髓损伤水平是与 SCI 男性较小的前列腺体积相关的唯一独立变量。
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