EXTRAPROSTATIC PRODUCTION OF PROSTATE-SPECIFIC ANTIGEN IS UNDER HORMONAL-CONTROL

Purpose: Prostate specific antigen (PSA) is the most useful tumor mark er in urology. It is produced primarily by the epithelial cells of the ducts and acini of the prostate gland. Extraprostatic production of P SA is provided mainly by the periurethral glands, leading to measurabl e urine but undetectable serum levels of PSA in women and in men follo wing radical prostatectomy for pathologically localized disease. Mater ials and Methods: We investigated the effect of continuous testosteron e substitution (250 mg. every 4 weeks) on urinary PSA excretion in 20 patients who converted from the female to male gender. We compared the results to urine levels in 20 women who did not receive testosterone. Results: Mean urinary PSA plus or minus standard deviation was 1.73 /- 1.68 ng./ml. in controls and 12.03 +/- 10.47 ng./ml. in converted p atients, a statistically significant difference (p < 0.0001). Serum PS A did not differ between groups. Conclusions: Our data demonstrate tha t extraprostatic PSA production is under androgen control.