Extraprostatic production of prostate specific antigen is under hormonal control.

Abstract

Prostate specific antigen (PSA) is the most useful tumor marker in urology. It is produced primarily by the epithelial cells of the ducts and acini of the prostate gland. Extraprostatic production of PSA is provided mainly by the periurethral glands, leading to measurable urine but undetectable serum levels of PSA in women and in men following radical prostatectomy for pathologically localized disease. We investigated the effect of continuous testosterone substitution (250 mg. every 4 weeks) on urinary PSA excretion in 20 patients who converted from the female to male gender. We compared the results to urine levels in 20 women who did not receive testosterone. Mean urinary PSA plus or minus standard deviation was 1.73 +/- 1.68 ng./ml. in controls and 12.03 +/- 10.47 ng./ml. in converted patients, a statistically significant difference (p < 0.0001). Serum PSA did not differ between groups. Our data demonstrate that extraprostatic PSA production is under androgen control.