Serum prostate-specific antigen concentrations are not useful for monitoring the treatment of hirsutism with oral contraceptive pills

Prostate-specific antigen (PSA) is produced in several female tissues, unde r the regulation of steroid hormones. Serum PSA levels are increased in wom en with hirsutism, and they correlate with serum androgen levels. Therefore , as a marker of androgen excess, measurement of serum PSA may play a role in monitoring the treatment of hirsutism with contraceptive pills. Sixteen hirsute patients were included in the study. Clinical and biochemic al variables, including serum PSA (using an ultrasensitive chemiluminescent immunoassay), total testosterone, sex hormone-binding globulin, androstene dione, dehydroepiandrosterone-sulfate, estradiol, and gonadotropin concentr ations were recorded at baseline and after 3 and 6 cycles of treatment with a monophasic contraceptive pill containing ethynylestradiol and desogestre l. Twenty-seven healthy women served as controls for serum PSA level and fo r the serum androgen profile. Serum PSA levels were higher in hirsute patients, as compared with healthy women (mean +/- SEM: 0.014 +/- 0.003 vs. 0.006 +/- 0.001 mu g/L, P < 0.02). Despite a marked decrease in serum androgens (total testosterone and andro stenedione, calculated free testosterone and free androgen index; and dehyd roepiandrosterone-sulfate) and in the hirsutism score, and a marked increas e in sex hormone-binding globulin levels, serum PSA levels did not change a nd remained detectable in all the hirsute patients after 3 and 6 cycles of treatment with contraceptive pills. In conclusion, the increased serum PSA levels present in hirsute patients d o not change during treatment with contraceptive pills and do not parallel the amelioration in hirsutism and the decrease in serum androgen concentrat ions that occur during this treatment. Thus, serum PSA measurements have no apparent role in the management of hirsute patients on oral contraceptive treatment, at least with the ultrasensitive assays currently available.