Is prostate-specific antigen a potential new marker of androgen excess in polycystic ovary syndrome?

AIM: To determine whether serum prostate-specific antigen (PSA) levels are increased in polycystic ovary syndrome (PCOS) and the possibility of PSA to be used as a diagnostic marker of hyperandrogenism in females.

METHODS

A total of 43 women with PCOS and 43 age-matched healthy females were recruited in this prospective case-control study. The subjects were compared by means of demographic parameters, hormonal and metabolic measures and serum PSA levels. The correlations between this marker and a wide variety of hormonal, biochemical, anthropometric measures were evaluated. Student's t-test, chi2-test and Spearman's correlation analysis were used for the statistical analysis where appropriate. Statistical significance was assumed with a value of P<0.05.

RESULTS

Mean body mass index, waist/hip ratio, Ferriman-Gallwey scores (FG), lutenizing hormone/follicle stimulating hormone ratio, insulin resistance, serum triglycerides and very low density lipoprotein levels were demonstrated to be significantly higher in PCOS (P=0.02, P=0.008, P<or=0.001, P<or=0.001, P=0.007, P<or=0.001, P=0.01, respectively). Total testosterone (TT), dehydroepiandrosteronesulfate (DHEAS) levels appeared to be significantly higher in PCOS (P=0.002, P<or=0.001, respectively). Serum PSA levels were found to be significantly higher in PCOS (PSA: 0.026+/-0.023 ng/mL in PCOS, PSA: 0.009+/-0.008 ng/mL in control cases, P<0.001). Sex hormone binding globulin (SHBG) was significantly lower in the subjects with PCOS (P<0.001). Additionally, positive correlations between PSA and FG scores (r: 0.417, P<or=0.001), PSA and TT (r: 0.456, P=0.03) and between PSA and DHEAS (r: 0.268, P=0.02) were found. A negative correlation between SHBG and PSA was apparent (r: -0.40, P=0.04).

CONCLUSION

PSA is a well-established tumor marker of prostatic adenocarcinoma. It is also shown to be produced by extraprostatic tissues and fluids. As the gene expression of PSA is upregulated by the androgens and progestins in hormonally responsive tissues, hyperandrogenic syndromes such as PCOS may be associated with elevated serum PSA levels. PSA appears to be a promising marker of endogenous androgen excess in females suffering from PCOS.