Serum Prostate-Specific Antigen Concentrations in Polycystic Ovary Syndrome: A Comparative Analysis of Hirsute and Non-Hirsute Phenotypes.

Abstract

Objective: Polycystic ovary syndrome (PCOS), affecting 5-10% of reproductive-aged women, is marked by anovulation and hyperandrogenism. Prostate-specific antigen (PSA), traditionally a prostate cancer biomarker, has also been detected in female tissues and proposed as a marker of androgen activity. This study examined whether serum total and free PSA differ between hirsute and non-hirsute PCOS phenotypes, hypothesizing higher levels in the hirsute group.

Methods: In this prospective case-control study, 90 women with PCOS diagnosed by the 2003 Rotterdam ESHRE/ASRM criteria were enrolled between May 2022 and January 2023. Participants were stratified into hirsute and non-hirsute groups using the modified Ferriman-Gallwey score. Demographic, clinical, and reproductive data were recorded, and venous blood samples collected on cycle days 2-3 were analyzed for PSA, androgens, and metabolic parameters. Insulin resistance was assessed using homeostatic model assessment of insulin resistance (HOMA-IR).

Results: Age did not differ between groups, but body mass index (BMI) (p = 0.044), acne prevalence (p = 0.032), and free testosterone (p = 0.014) were significantly higher in hirsute women. Amenorrhea and oligomenorrhea were more frequent in the non-hirsute group (p = 0.012). Ovarian morphology, alopecia, and PSA levels showed no significant differences between groups (all p > 0.05). However, Spearman rank correlation analysis revealed significant positive correlations between PSA and Ferriman-Gallwey score (r_s = 0.896, p < 0.001), total testosterone (r_s = 0.779, p < 0.001), HOMA-IR (r_s = 0.838, p < 0.001), DHEA-S (r_s = 0.807, p < 0.001), and LH (r_s = 0.804, p < 0.001).

Conclusions: Hirsute phenotypes demonstrated clustered hyperandrogenic features, including higher free testosterone, BMI, and acne prevalence. Although PSA levels did not differ between phenotypic groups, the significant positive correlations with hirsutism score and metabolic parameters suggest that PSA may reflect androgenic-metabolic activity in PCOS, underscoring the heterogeneity of the syndrome and the need for comprehensive phenotypic assessment.