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Is there a Clinically Useful Relationship between Testosterone and Prostate Specific Antigen in Patients with Lower Urinary Tract Symptoms?

Raman Tanwar, Rajeev Sood, Nikhil Khattar and Arif Akhtar

Introduction: Relationship between Testosterone and Prostate Specific Antigen (PSA) in patients with Lower urinary Tract Symptoms (LUTS) is ambiguous. The present study aims to establish the relationship of these variables in patients with LUTS, with a larger study cohort. Methods: A retrospective study was done over a period of 4 years at a tertiary care center. Free and total PSA were correlated with age, prostate volume and Testosterone using appropriate statistical tests in 1156 patients. Patients were stratified into two groups based on PSA level of 4 ng/ml and correlation was studied separately. Results: A weak negative correlation was present between free PSA and Testosterone levels (-0.182, p<0.001) and total PSA and Testosterone levels (-0.223, p<0.001) and between prostate volume and serum Testosterone (-0.45, p<0.001). Volume correlated positively with free and total PSA. When groups were independently analysed no significant correlation was found between Testosterone and PSA in patients with PSA >4 ng/ml but a weak negative correlation was found between free PSA and Testosterone (-0.156, p<0.001). Conclusion: In patients with LUTS, Testosterone and PSA levels are poorly interrelated especially when PSA is more than 4 mg/ml. There is a need to explore whether this weak association between PSA, prostate volume and total Testosterone is of any clinical utility.