A. Morgentaler et al., OCCULT PROSTATE-CANCER IN MEN WITH LOW SERUM TESTOSTERONE LEVELS, JAMA, the journal of the American Medical Association, 276(23), 1996, pp. 1904-1906
Objective.-To determine the prevalence of occult prostate cancer in me
n with low serum total testosterone or free testosterone levels. Desig
n.-Retrospective analysis of a consecutive series of men. Setting.-Aca
demic teaching hospital. Patients.-Seventy-seven men with low total te
stosterone or free testosterone levels, with normal results of digital
rectal examination and prostate-specific antigen (PSA) levels of 4.0
ng/mL or less. The mean age was 58 years. Interventions.-Sextant prost
ate needle biopsies with ultrasound guidance. Main Outcome Measures.-R
esults of prostate needle biopsies, transrectal ultrasound, prostate v
olume, PSA level, PSA density, total and free testosterone levels. Res
ults.-Prostate cancer was identified in 14% (11/77) of the entire grou
p and in 10 men (29%) aged 60 years or older. The median age for men w
ith cancer was 64 years. Histologic examination showed Gleason scores
of 6 or 7 for all cancers. No significant differences were noted betwe
en the cancer and benign groups with regard to PSA level, PSA density,
prostate volume, total testosterone level, or free testosterone level
. Conclusions.-A high prevalence of biopsy-detectable prostate cancer
was identified in men with low total or free testosterone levels despi
te normal PSA levels and results of digital rectal examination. These
data suggest that (1) digital rectal examination and PSA levels are in
sensitive indicators of prostate cancer in men with low total or free
testosterone levels, and (2) PSA levels may be altered by naturally oc
curring reductions in serum androgen levels.