scholarly journals Prostate-Specific Antigen Concentrations in Response to Testosterone Treatment of Severely Hypogonadal Men

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Saachi Sachdev ◽  
Andrew J Cucchiara ◽  
Peter J Snyder
Keyword(s):  
Prostate Specific Antigen ◽  
Clinical Guidelines ◽  
Medical Center ◽  
Academic Medical Center ◽  
Specific Antigen ◽  
Testosterone Replacement ◽  
Endocrine Society ◽  
Testosterone Treatment ◽  
Psa Response ◽  
Testicular Disease

Abstract Context Clinical guidelines recommend measurement of the serum prostate-specific antigen (PSA) concentration during testosterone treatment of hypogonadal men to determine whether the increase is sufficiently high to warrant urologic referral. Prior studies of the effect of testosterone treatment on PSA concentrations have been conducted in men who were mildly to moderately hypogonadal. Objective The objective of this work is to determine the PSA response to testosterone treatment of men who are severely hypogonadal. Design and Setting This retrospective cohort study was conducted at a single academic medical center. Participants Eighty-five men participated who were severely hypogonadal as a result hypothalamic-pituitary or testicular disease. Main Outcome Measure Changes in serum PSA concentrations were measured during testosterone treatment for up to 18 months. Results Testosterone treatment increased the median serum testosterone concentration from 36 ng/dL (interquartile range [IQR], 20-91 ng/dL) at baseline to 395 ng/dL (IQR, 266-542 ng/dL) at 6 to 18 months. This treatment resulted in a median increment in PSA above baseline of 0.70 ng/mL (IQR, 0.10-1.85 ng/mL) at 6 to 18 months. Apropos current Endocrine Society clinical guidelines, 31% of the men experienced a PSA increase above baseline greater than 1.4 ng/mL, and 13% reached an absolute PSA concentration of greater than 4.0 ng/mL. Four men were diagnosed with prostate cancer. Conclusions The PSA response to testosterone replacement in men who are severely hypogonadal as a result of pituitary or testicular disease is greater than that previously reported in men with mild to moderate hypogonadism. These results suggest the magnitude of the PSA response to testosterone replacement is related to the degree of hypogonadism.

Do patients and physicians perceive PSA screening discussions the same?

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 160-160
Author(s):  
James Austin Talcott ◽  
Gina Aharonoff ◽  
Maureen Bezuhly ◽  
Michael P. Osborne
Keyword(s):  
Decision Making ◽  
Randomized Trial ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Academic Medical Center ◽  
Specific Antigen ◽  
Educational Interventions ◽  
Screening Methods ◽  
Psa Screening ◽  
Psa Testing

160 Background: Shared decision making is recommended for prostate-specific antigen (PSA) screening. We are performing a prospective randomized trial of educational interventions to improve screening compliance at an urban academic medical center. We hypothesize that patient and provider characteristics providers will affect compliance. We report the first results for PSA screening. Methods: In a cluster-randomized trial of educational supports for providers, we are recruiting an age- and sex-stratified sample of 216 patients aged 30 to 89 years undergoing an annual physical examination, 18 patients of each of 12 primary care physicians at two affiliated hospitals. Screening guideline format (color-coding) and academic detailing were randomly assigned in a 2 x 2 design. Surveys occurred immediately post-encounter to record recollections of screening discussions, recommendations and plans. Results: We report on the first 44 of 108 planned male participants. Most were white (77%), had a college degree (83%), and currently married (59%). When providers reported a PSA discussion, 13% of patients disagreed, while 23% of patients disagreed when their provider reported a PSA discussion. Discrepancies also occurred on additional elements of informed decision-making (data not shown). Reports also disagreed on physician recommendations: 2 of 8 patients (25%) disagreed with the physician’s report of recommending screening and 6 of 12 patients (50%) disagreed with the physician’s report of not recommending it. Half of patients (49%) reported distress at getting PSA results, but only 5% reported “a lot” of distress. Over half (58%) reported that PSA testing protected against prostate cancer “a lot.” No physician reported recommending PSA testing to men under age 50 or over age 70, but 1 of 6 men under 50 and 3 of 3 men over 70 reported that their physician had recommended testing. Conclusions: In a highly educated population of men and physicians surveyed immediately after their encounter, reports of whether PSA screening had occurred, the information that had been discussed and the recommendation had important discrepancies. Important differences may exist between patients and physicians in perceptions of PSA screening discussions. Clinical trial information: NCT02430948.

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