Prostate-specific antigen (PSA) is a
serine proteases produced by prostatic epithelial cells detectable in male serum and seminal plasma. PSA is also expressed in some female tissues and fluids and is increased in hirsute women showing a positive correlation with
androgens. Accordingly, it has been suggested that PSA might be a marker of
androgen action in women. The aim of this observational study was to assess serum PSA concentration in acro megalic women with active disease, in remission or during
somatostatin analogs
therapy. Forty-four acromegalic women, 15 with active disease, 10 in remission and 19 under long-acting
somatostatin analogs
therapy were enrolled in the study; 273 normal women matched for age, body mass index, with no signs of
hirsutism, served as controls. Serum PSA, 3a-androstanediol (3alpha-AG), total
testosterone (T), DHEAS, LH, FSH and
estradiol were assessed. No patient or control had been given
estrogen or
antiandrogen drugs; no acromegalic women had
hyperprolactinemia or
hypopituitarism. Serum PSA concentration was significantly higher in acromegalic patients than in control subjects (p < 0.0001). Patients with active
acromegaly or under
somatostatin analogs
therapy had significant higher serum PSA concentration than controls, while patients in remission after adenomectomy did not differ. Serum PSA was detectable in serum of 75% acromegalic women and 45% of controls. In addition 24% of acromegalic women had serum PSA concentrations higher than the mean +/- 2SD of control subjects. Differences in serum PSA levels did not reach statistical significance in the different acromegalic subgroups possibly because of the small number of subjects, but patients with active
acromegaly had higher serum PSA levels than patients under
somatostatin analogs
therapy or in remission. Acromegalic women had significantly higher serum PSA concentrations than controls both before and after menopause (p < 0.01). 3alpha-AG (p < 0.05) and T (p < 0.01) were higher in acromegalic than in control subjects in pre-menopause (PM) but not in post-menopause (M). A correlation was found in the whole group of acromegalic patients between serum PSA and 3a-AG concentrations (r = 0.3, p < 0.01). In conclusion, acromegalic is associated with an increase in serum PSA concentrations as a group, although this increase is observed, at an individual level, in only 24% of cases. Patients whose disease is controlled by
somatostatin analogs or has been cured by pituitary adenomectomy tend to have lower serum PSA levels than patients with active disease. M patients tend to have lower PSA values than PM women, consistent with the main
androgen control of PSA production. However, the observation that M women still have higher serum PSA levels than controls suggest that in
acromegaly PSA is regulated not only by
androgens but also by the GH/
IGF-I system itself.