Hormonal Biomarkers in Predicting Prostate and Clinically Significant Prostate Cancer: A Prospective Study.

Abstract

Background: Prostate cancer (PCa) is the most commonly diagnosed cancer in men worldwide. Prostate-specific antigen (PSA) is widely used in PCa suspicion but lacks specificity. Additional markers, such as PSA density, free:total PSA ratio and multiparametric prostate magnetic resonance imaging (MRI), are employed. This study evaluated the role of hypothalamo-pituitary axis hormones and adrenal-derived androgens in predicting PCa and clinically significant PCa (csPCa).

Patients and methods: This prospective cohort study included 464 male patients scheduled for transrectal prostate biopsy due to elevated PSA or abnormal digital rectal examination findings. Patients were divided into two groups on the basis of biopsy results: Group 1 (benign) and Group 2 (PCa). Prebiopsy levels of PSA, total testosterone (TTE), luteinising hormone (LH), follicle-stimulating hormone (FSH), oestradiol (EST), prolactin (PRL), testosterone density (TTEd), PSA density (PSAd) and dehydroepiandrosterone sulphate (DHEAS) were examined. Patients were also categorised into three groups to assess csPCa: Group A (no malignancy or clinically insignificant PCa), Group B (csPCa) and Group C (clinically insignificant PCa).

Results: Group 2 had significantly lower DHEAS levels (p = 0.03) and higher TTEd (p < 0.05) and PSAd (p < 0.05) levels than Group 1. No significant differences were found in FSH, LH, EST, TTE and PRL levels between groups (p > 0.05). The comparison of patients with csPCa (Group B) with patients in other groups revealed that DHEAS (p < 0.05) levels were significantly lower and PSAd (p < 0.05) was significantly higher in Group B than in other groups. DHEAS levels showed a negative correlation with age (r = -0.387, p < 0.05). In patients over 65 years of age, low DHEAS levels were significantly associated with csPCa (p < 0.05).

Conclusions: Serum PSA alone is insufficient for PCa diagnosis. DHEAS and TTEd are useful in predicting PCa and csPCa. The decrease in DHEAS levels is associated with an increased risk of PCa and csPCa, suggesting its potential role as a marker in patient management. Further large-scale studies are needed to confirm these findings.