Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea.
Department of Health Administration, Dankook University, Korea.
Andrology. 2020 Sep;8(5):1194-1213. doi: 10.1111/andr.12806. Epub 2020 May 18.
Serum testosterone assays are an important tool in the clinical evaluation of a number of endocrine disorders including male hypogonadism. However, serum testosterone has a limited role in real clinical use due to its inaccuracy. We aimed to assess the association between prostate-specific antigen (PSA) and testosterone as well as the effects of various types of testosterone replacement therapy (TRT) for PSA level.
Two electronic databases were screened: PubMed (1966 through December 2018) and Cochrane Library (1993 through December 2018). The first strategy compared the overall increase in PSA following testosterone treatment compared with placebo. The second strategy analyzed the overall association between PSA and testosterone among the observational studies.
In the first strategy, 22 articles were included in the final analysis. In the second strategy, 18 studies were included. Testosterone replacement therapy (TRT) showed a significant change in PSA level compared to that in the placebo group (mean difference [MD]: 0.13, 95% CI: 0.01-0.25, P = .04). Compared to placebo, only intramuscular (IM) TRT shows a significant change in PSA level group (MD: 0.16, 95% CI: 0.01-0.30, P = .04), as neither the oral nor topical type showed a significant change in PSA. In the second strategy analysis, there was no overall correlation found between PSA and testosterone (z = 0.04, 95% CI: -0.04 to 0.12, P = .04; r = 0.039). However, in the subgroup of non-BPH (benign prostate hyperplasia), a significant correlation between PSA and testosterone (z = 0.07, 95% CI: 0.01-0.13, P = .009; r = 0.089) was found.
We found that TRT, particularly IM TRT, significantly changed the PSA level compared with the placebo group. Furthermore, there was a significant correlation between PSA and testosterone in patients with non-BPH. According to these findings, we suggest the possibility of PSA as a surrogate marker of testosterone.
血清睾酮检测是评估多种内分泌疾病（包括男性性腺功能减退症）的重要工具。然而，由于其准确性有限，血清睾酮在实际临床应用中的作用有限。我们旨在评估前列腺特异性抗原（PSA）与睾酮之间的关系，以及各种类型的睾酮替代治疗（TRT）对 PSA 水平的影响。
筛选了两个电子数据库：PubMed（1966 年至 2018 年 12 月）和 Cochrane 图书馆（1993 年至 2018 年 12 月）。第一个策略比较了睾酮治疗后 PSA 总体升高与安慰剂的差异。第二个策略分析了观察性研究中 PSA 与睾酮之间的总体相关性。
在第一个策略中，有 22 篇文章被纳入最终分析。在第二个策略中，有 18 项研究被纳入。与安慰剂相比，TRT 治疗组 PSA 水平有显著变化（平均差异[MD]：0.13，95%置信区间：0.01-0.25，P=0.04）。与安慰剂相比，只有肌内（IM）TRT 组 PSA 水平有显著变化（MD：0.16，95%置信区间：0.01-0.30，P=0.04），而口服或局部类型均未显示 PSA 有显著变化。在第二个策略分析中，未发现 PSA 与睾酮之间存在总体相关性（z=0.04，95%置信区间：-0.04 至 0.12，P=0.04；r=0.039）。然而，在非 BPH（良性前列腺增生）亚组中，发现 PSA 与睾酮之间存在显著相关性（z=0.07，95%置信区间：0.01-0.13，P=0.009；r=0.089）。
我们发现，TRT，特别是 IM TRT，与安慰剂组相比，显著改变了 PSA 水平。此外，在非 BPH 患者中，PSA 与睾酮之间存在显著相关性。根据这些发现，我们提出 PSA 作为睾酮替代标志物的可能性。
