Prostate Restored
Prostate Restored
Photo: Ashley Nazario
We analyzed the correlation between prostate volume and relevant factors, as well as the correlation between changes in prostate volume and low testosterone over a 4-year period. Men with low testosterone had significantly larger prostate volume than those in the normal testosterone group (26.86 ± 8.75 vs.
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Read More »The association between total testosterone levels and prostate volume has been controversial. The results of the present study show that TT level was negatively correlated with PV after adjusting for age in Chinese aging men. Meanwhile, the rate of PV growth in aging patients with low testosterone was significantly greater than the normal TT level group after adjusting for age. As an increasing number of countries have aging societies, scientists are concerned about symptoms in older men associated with changes in sex hormones, particularly changes in testosterone levels22. Testosterone levels decrease with age, a syndrome defined by the ISSAM (International Society for the Study of the Aging Male) as androgen deficiency or late-onset hypogonadism, which can cause a number of physical complaints, including decreased libido, erectile quality, and intellectual activity; fatigue; depression; and irritability23. An observational cross-sectional study of testosterone and age found that TT and free testosterone decreased with age (0.4%/year and 1.2%/year)24. Feldman, H A also found that serum testosterone levels declined steadily after age 40, with an average annual decrease of 0.8% in TT. Furthermore, deteriorating health may accelerate age-related declines in testosterone levels based on longitudinal data22. Our results showed that subjects in the low androgen group were older than those in the control group, but there was no significant difference. This may have been related to the androgen grouping. In the present study, there was an association between age and TT (P = 0.002). Obesity was also associated with decreased TT levels in the prospective prevalence study of Calderon, B et al.25, which determined that 45% of moderately to severely obese patients had low testosterone levels, and serum TT levels were negatively correlated with blood glucose and insulin resistance. Studies have also found that the proportion of subnormal free testosterone in obese subjects is significantly higher than that in normal and lean people, and free testosterone was negatively correlated with BMI (r = − 0.18 P < 0.001) and significantly lower in diabetic patients. Our results also showed that subjects in the low testosterone group had significantly higher waist circumference and BMI, as well as higher insulin levels and HOMA IR, than those in the normal testosterone group. In contrast to the relationship between TT and age, the prevalence of BPH increased significantly with age2. Some retrospective studies have also shown that there is a positive correlation between age and PV; meanwhile, the fastest increasing rate of PV was between the ages of 50 and 691,26. In our study, we found a significant correlation between prostate volume and age (P = 0.030, data not shown). As with TT, PV was also associated with obesity and insulin, and Vignozzi, L et al. found that obesity and insulin could have a detrimental effect on the prostate and are a risk factor for BPH progression27. A similar study indicated that PV significantly correlated with fasting serum insulin (P = 0.028). In our study, there was a positive correlation between PV with insulin and insulin resistance. Thus, age and obesity-related factors are both correlated with TT and PV. Some studies have looked at the relationship between serum androgen levels in men and clinical prostatic hyperplasia or prostate volume, but the results have been inconsistent. Meikle et al.15 found that PV was negatively correlated with age-adjusted serum TT, DHT, and SHBG levels in 214 male twins between 25 and 75 years old. Another study came to a similar conclusion in Asians; with decreased TT, the IPSS score and PV all significantly increased10. Roberts et al. indicated that PV was negatively associated with bioavailable testosterone level (rs = − 0.13, P < 0.05). However, after adjusting for age, the results were not statistically significant13. In contrast, Nukui M et al.35 found that PV was positively correlated with TT, but this finding only existed in groups with PV > 25 ml in a cross-sectional study of 226 subjects. Other studies have also failed to find a significant association between TT level and PV12,14.
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Read More »In fact, both TT and PV are correlated with race and age, and the heterogeneity of different studies may arise from the differences in age and region of the subjects. Our present results suggest that there is a significant negative association between PV and TT levels after age adjustment, and subjects with low testosterone levels had significantly larger prostate volumes than men with normal testosterone levels after 4 years. After adjusting for age, BMI and insulin levels, there was no statistical association between PV and TT levels; however, there was still a statistical correlation between increased PV over 4 years and TT levels (OR = 2.642 P < 0.001). Similar to our current findings, a cross-sectional study of 406 Australians found a negative correlation between age and serum testosterone levels (r = − 0.265; P < 0.001), and BMI was inversely correlated to TT (r = − 0.42; P < 0.001). After adjusting for age and sampling time, PV measured by transrectal ultrasound was negatively correlated with TT, free testosterone, and bioavailable testosterone36. TRT is increasingly used in older men. A study of 13 hypogonadal men aged 25 to 35 who underwent TRT found a significant increase in PV (P < 0.001)27. Other longitudinal researchers have shown that testosterone supplementation increases PV by an average of 12%29. However, Morales30 found that there was no significant difference in PV between men treated with testosterone and those treated with placebo. A well-controlled RCT study of 44 men with hypogonadism showed no significant increase in testosterone levels in prostate tissue and little change in treatment-related prostate volume in men treated with TRT, despite significantly increased serum TT levels31. Long-term testosterone therapy in hypogonadal men showed significant improvements in urinary function and QoL, and PV was also correlated with testosterone treated32. In a similar study, testosterone-treated group showed a smaller increase in PV after eight years than control group33. It is possible that TRT may affect normal or low gonadal function in men with primary hypogonadism, but there is a lack of confirmation in men with aging hypogonadism. In the present study, increased serum TT and PV levels showed a linear trend of significant decrease. Among sex hormones other than TT, Schatzl et al.34 found that estradiol (but not testosterone) was associated with PV (r = 0.17, P = 0.01). Joseph et al.14 found that SHBG and endogenous steroid hormones were correlated with prostate volume, with SHBG being negatively correlated. Our study also found a negative correlation between SHBG and PV (P = 0.042). In older men, however, the relationship between sex steroids and PV is more complex than a single effect. Further systematic studies are needed to analyze the correlation between all sex hormones and PV.
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Read More »This article has some shortcomings that need to be noted. Firstly, the study was implemented in a single institution setting, which may be subject to selection bias and is not fully representative of the overall population. Further scaling is needed to validate our results. Second, the current cross-sectional study cannot reach an accurate conclusion and can only provide some evidence for the follow-up study, which requires further longitudinal and prospective studies. Third, compared with mass spectrometry-based measurements, immunoassay may not be the most accurate method when serum testosterone levels are low due to the introduction of random noise into the models. Measurement errors should be reduced as much as possible by professional and skilled laboratory personnel. A further limitation was that subjects in the present study were older on average, which may have led to some other complications of aging that affect PV, such as diabetes or metabolic syndrome. The effects of these age-related diseases on the prostate are very complex and difficult to fully correct, and the mechanism by which androgen deficiency in aging men influences PV should be further studied.
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