Additional value of the ratio of serum total testosterone to total prostate‐specific antigen in the diagnosis of prostate cancer in a Chinese population

Summary We investigated whether serum testosterone and testosterone/prostate‐specific antigen ratio (T/ PSA ) might be prostate cancer ( PC a) biomarkers. We retrospectively reviewed 92 patients with benign prostatic hyperplasia ( BPH ) and 164 patients with PC a treated at Zhongshan Hospital, China (April 2012 to November 2013). The BPH and PC a groups had similar serum total testosterone (median, 15.8 versus 16.3 nmol/L).Compared with the BPH group, the PC a group had higher PSA (16.8 versus 5.1 ng/ml) and lower free/total PSA (9.5% versus 19.3%) and T/ PSA (1.37 versus 4.69) (all p  <   .001).Patients with PC a and PSA ≤20 ng/ml had higher testosterone (17.5 versus 12.9 ng/ml; p  =   .002) and T/ PSA (2.24 versus 0.29; p  <   .001) than those with PSA >20 ng/ml. Patients with PC a and Gleason score ≤7 had higher testosterone (18.3 versus 14.1 ng/ml; p  =   .023) and T/ PSA (1.93 versus 0.72; p  <   .001) than those with Gleason score >7. In patients with PSA ≤20 ng/ml, T/ PSA was higher in those with BPH than in those with PC a (4.69 versus 2.24; p  <   .001). ROC curve analysis yielded an AUC of 0.712; for the optimal cut‐off of 4.43, specificity and sensitivity were 52% and 97% respectively. T/ PSA may improve the accuracy of PC a diagnosis in patients with a PSA level ≤20 ng/ml.