Occult prostate cancer in men with low serum testosterone levels.

Occult prostate cancer in men with low serum testosterone levels.
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血清睾酮水平低的男性患有隐匿性前列腺癌。

DOI：
10.1001/jama.1996.03540230054035
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发表时间：
1996
期刊：
JAMA
影响因子：
--
通讯作者：
W. DeWolf
W. DeWolf
中科院分区：
--
文献类型：
--
作者：
A. Morgentaler;C. Bruning;W. DeWolf

文献摘要

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目的 确定血清总睾酮或游离睾酮水平低的男性中隐匿性前列腺癌的患病率。 设计 对一系列连续的男性进行回顾性分析。 设置 学术教学医院。 患者 77例男性，总睾酮或游离睾酮水平低，直肠指检结果正常，前列腺特异性抗原（PSA）水平≤ 4.0 ng/mL，平均年龄58岁。 干预措施 超声引导下的前列腺穿刺活检。 主要观察指标 前列腺穿刺活检、经直肠超声、前列腺体积、PSA水平、PSA密度、总睾酮和游离睾酮水平的结果。 结果 在整个组的14%（11/77）和10名60岁或以上的男性（29%）中发现了前列腺癌。男性癌症患者的中位年龄为64岁。组织学检查显示所有癌症的Gleason评分为6或7。前列腺癌组和良性前列腺癌组在PSA水平、PSA密度、前列腺体积、总睾酮水平或游离睾酮水平方面无显著差异。 结论 尽管PSA水平和直肠指检结果正常，但在总睾酮或游离睾酮水平低的男性中，活检可检测到的前列腺癌患病率较高。这些数据表明，（1）直肠指检和PSA水平是低总或游离睾酮水平的男性前列腺癌的不敏感指标，（2）PSA水平可能会因血清雄激素水平的自然降低而改变。
OBJECTIVE To determine the prevalence of occult prostate cancer in men with low serum total testosterone or free testosterone levels. DESIGN Retrospective analysis of a consecutive series of men. SETTING Academic teaching hospital. PATIENTS Seventy-seven men with low total testosterone 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 prostate needle biopsies with ultrasound guidance. MAIN OUTCOME MEASURES Results of prostate needle biopsies, transrectal ultrasound, prostate volume, PSA level, PSA density, total and free testosterone levels. RESULTS Prostate cancer was identified in 14% (11/77) of the entire group and in 10 men (29%) aged 60 years or older. The median age for men with cancer was 64 years. Histologic examination showed Gleason scores of 6 or 7 for all cancers. No significant differences were noted between 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 despite normal PSA levels and results of digital rectal examination. These data suggest that (1) digital rectal examination and PSA levels are insensitive indicators of prostate cancer in men with low total or free testosterone levels, and (2) PSA levels may be altered by naturally occurring reductions in serum androgen levels.