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Infertile men have higher prostate-specific antigen values than fertile individuals of comparable age

  • Luca Boeri,
  • Paolo Capogrosso,
  • Walter Cazzaniga,
  • Eugenio Ventimiglia,
  • Edoardo Pozzi,
  • Federico Belladelli,
  • Nicolò Schifano,
  • Luigi Candela,
  • Massimo Alfano,
  • Filippo Pederzoli,
  • Costantino Abbate,
  • Emanuele Montanari,
  • Luca Valsecchi,
  • Enrico Papaleo,
  • Paola Viganò,
  • Patrizia Rovere-Querini,
  • Francesco Montorsi,
  • Andrea Salonia

Background

Infertile men are at greater risk for oncological and nononcological chronic disease than fertile individuals.

Objective

To investigate prostate-specific antigen (PSA) values in men presenting for primary couple’s infertility compared with a cohort of fertile individuals, according to the recommendation of the European Association of Urology guidelines that a first PSA assessment should be done at 40–45 yr of age.

Design, setting, and participants

This is a cross-sectional study. Data from 956 (90%) infertile men and 102 (9.6%) fertile participants were analysed. Circulating hormones, total PSA, and semen parameters were investigated in every man.

Outcome measurements and statistical analysis

Descriptive statistics, local polynomial smoothing, and linear regression models were used to test potential associations with PSA levels.

Results and limitations

Overall, PSA >1 ng/ml was found in 318 (30%) men. Serum PSA was higher (p = 0.02), while serum testosterone (p < 0.01) was lower in infertile than in fertile men. In participants younger than 40 yr, 176 (27%) men had PSA >1 ng/ml; of them, a greater proportion were infertile (28% infertile vs 17% fertile, p = 0.03). At multivariable linear regression analysis, infertile status (coefficient 0.21; 95% confidence interval 0.02–0.39) was associated with higher PSA values, after adjusting for age and serum testosterone level. This was a single-centre study, raising the possibility of selection biases.

Conclusions

Infertile men have higher PSA values than fertile individuals. Of all, almost one out of three primary infertile men younger than 40 yr has a first total PSA value of >1 ng/ml.