Original Study| Volume 31, ISSUE 3, P263-269, June 2018

Download started.


The Value of Prostate-Specific Antigen in Diagnosis of Polycystic Ovarian Syndrome in Adolescent Girls

Published:November 20, 2017DOI:


      Study Objective

      This study was designed to evaluate and compare the serum total prostate-specific antigen (PSA) levels in adolescent girls in with and without polycystic ovarian syndrome (PCOS) to show whether evaluation of PSA levels have a diagnostic benefit over existing diagnostic criteria.


      Case-control study.


      A territory referral center.


      A total of 89 (15-19 years) nonobese (body mass index, 18-24.9) adolescents with PCOS (n = 42) and controls without PCOS (n = 47) were enrolled in the study.


      Pathophysiological features of PCOS and serum total PSA levels were determined at the time of study enrollment.

      Main Outcome Measures

      Determination, comparison, and diagnostic performance of serum total PSA levels in diagnosis of PCOS in adolescent girls were the main outcome measures of the study.


      The serum total PSA levels of adolescents with PCOS were detected to be higher than for control participants (0.63 ± 1.38 ng/mL vs 0.48 ± 0.95 ng/mL) without meeting statistical significance (P = .923). There was a correlation between total PSA levels and indices of insulin resistance like the homeostasis insulin resistance model (r = 0.414; P = .010). The serum total PSA level was not a discriminative parameter for diagnosis of PCOS in adolescent girls (area under the curve, 0.559; P = .476).


      The serum total PSA level was not a predictor of PCOS in adolescent girls. This finding might be related to the extemporal nature of tissues capable of PSA production and lack of sufficient exposure interval to hyperandrogenemia, rather than lack of stimulatory relationship between serum androgens.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zawadski J.K.
        • Dunaif A.
        Diagnostic criteria for poly cystic ovary syndrome: towards a rational approach.
        in: Dunaif A. Givens J.R. Haseltine F.P. Merriam G.R. Polycystic Ovary Syndrome. Blackwell Scientific Publications, Cambridge1992: 377-384
        • Rotterdam ESHRE/ASRM Sponsored PCOS Consensus Workshop Group
        Revised 2003 consensus on diagnostic criteria and long term health risks related to polycystic ovary syndrome.
        Fertil Steril. 2004; 81: 19
        • Oliveiraa A.
        • Sampaio B.
        • Teixeirac A.
        • et al.
        Polycystic ovary syndrome: challenges in adolescence.
        Endocrinol Nutr. 2010; 57: 328
        • World Health Organization Task Force on Adolescent Reproductive Health
        World Health Organization multicenter study in menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early post-menarchal period, duration of bleeding episodes and menstrual cycles.
        J Adolesc Health Care. 1986; 7: 236
        • Mortenson M.
        • Rosenfield R.L.
        • Littlejohn E.
        Functional significance of polycystic sized ovaries in healthy adolescents.
        J Clin Endocrinol Metab. 2006; 91: 3786
        • Sultan C.
        • Paris F.
        Clinical expression of polycystic ovary syndrome in adolescent girls.
        Fertil Steril. 2006; 86: S6
        • Diamandis E.P.
        • Yu H.
        Nonprostatic sources of PSA.
        Urol Clin North Am. 1997; 24: 275
        • Lilja H.
        Structure, function, and regulation of the enzyme activity of PSA.
        World J Urol. 1993; 11: 188
        • Gullu S.
        • Emral R.
        • Asik M.
        • et al.
        Diagnostic value of prostatic specific antigen in hirsute women.
        J Endocrinol Invest. 2003; 26: 1198
        • Ferriman D.
        • Gallwey J.D.
        Clinical assessment body hair growth in women.
        J Clin Endocrinol Metab. 1961; 21: 1440
        • Fruzzetti F.
        • Perini D.
        • Lazzarini V.
        • et al.
        Hyperandrogenemia influences the prevalence of the metabolic syndrome abnormalities in adolescents with the polycystic ovary syndrome.
        Gynecol Endocrinol. 2009; 25: 335
        • Wiksten-Almstromer M.
        • Hirschberg A.L.
        • Hagenfeldt K.
        Prospective follow-up of menstrual disorders in adolescence and prognostic factors.
        Acta Obstet Gynecol Scand. 2008; 87: 1162
        • Witchel S.F.
        • Oberfield S.
        • Rosenfield R.L.
        • et al.
        The diagnosis of polycystic ovary syndrome during adolescence.
        Horm Res Paediatr. 2015; 83: 376
        • Adityan B.
        • Kumari R.
        • Thappa D.M.
        Scoring systems in acne vulgaris.
        Indian J Dermatol Venereol Leprol. 2009; 75: 323
        • Legro R.S.
        • Arslanian S.A.
        • Ehrmann D.A.
        • et al.
        diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2013; 98: 4565
        • Torres O.
        • Witchel S.
        • Rofey D.
        • et al.
        Reducing provider variation in the diagnosis of polycystic ovarian syndrome.
        J Adolesc Health. 2017; 60: S103
        • Mardanian F.
        • Heidari N.
        Diagnostic value of prostate-specific antigen in women with polycystic ovary syndrome.
        J Res Med Sci. 2011; 16: 999
        • Bili E.
        • Dampala K.
        • Iakovou I.
        • et al.
        The combination of ovarian volume and outline has better diagnostic accuracy than prostate-specific antigen (PSA) concentrations in women with polycystic ovarian syndrome (PCOs).
        Eur J Obstet Gynecol Reprod Biol. 2014; 179: 32
        • Bayatti A.A.
        • Samak S.H.
        • Bahar A.J.
        Can serum prostate-specific antigen be a promising marker for patients with polycystic ovary syndrome and hirsutism.
        Middle East Fertil Soc J. 2004; 9: 227
        • Obiezu C.V.
        • Scorilas A.
        • Magklara A.
        • et al.
        Prostate specific antigen and human glandular kallikrein 2 are markedly elevated in urine of patients with polycystic ovary syndrome.
        J Clin Endocrinol Metab. 2001; 4: 1558
        • Melegos D.N.
        • Yu H.
        • Ashok M.
        • et al.
        Prostate-specific antigen in female serum, a potential new marker for androgen excess.
        J Clin Endocrinol Metab. 1997; 82: 777
        • Rudnicka E.
        • Radowicki S.
        • Suchta K.
        Prostate specific antigen (PSA) in diagnosis of polycystic ovarian syndrome - a new insight.
        Gynecol Endocrinol. 2016; 32: 931
        • Vural B.
        • Ozkan S.
        • Bodur H.
        Is prostate-specific antigen a potential new marker of androgen excess in polycystic ovary syndrome?.
        J Obstet Gynaecol Res. 2007; 33: 166
        • Federative Committee on Anatomical Terminology
        Terminologia Histologica: Human Cytology and Histology.
        Lippincott Williams & Wilkins, Cardiff2008
        • Zaviacic M.
        • Jakubovska V.
        • Belosovic M.
        • et al.
        Ultrastructure of the normal adult human female prostate gland (Skene’s gland).
        Anat Embryol (Berl). 2000; 201: 51
        • Price D.
        Comparative aspects of development and structure in the prostate.
        Natl Cancer Inst Monogr. 1963; 12: 1
        • Zaviacic M.
        The Female Prostate: from Vestigial Skene’s Parauretral Glands and Ducts to Woman’s Functional Prostate.
        Slovack Academic Press, Bratislava, Slovakia1999
        • Tepper S.L.
        • Jagirdar J.
        • Heath D.
        • et al.
        Homology between the female paraurethral (Skene’s) glands and the prostate.
        Arch Pathol Lab Med. 1984; 108: 423
        • Zaviacic M.
        Update on the female prostate and the phenomenon of female ejaculation.
        J Sex Res. 1993; 30: 148
        • Szell N.
        • Komisaruk B.
        • Goldstein S.W.
        • et al.
        A meta-analysis detailing overall sexual function and orgasmic function in women undergoing midurethral sling surgery for stress incontinence.
        Sex Med. 2017; 5: e84
        • Chan D.W.
        • Booth A.R.
        • Diamandis E.P.
        Tumour markers.
        in: Tietz Text Book of Clinical Chemistry and Molecular Diagnostics. 4th ed. 2006: 745-786
        • Diamandis E.P.
        • Yu H.
        New biological functions of prostate-specific antigen?.
        J Clin Endocrinol Metab. 1995; 80: 1515
        • Oesterling J.E.
        • Jacobsen S.J.
        • Chute C.G.
        • et al.
        Serum prostate-specific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges.
        JAMA. 1993; 270: 860
        • Tomlinson D.C.
        • Freestone S.H.
        • Grace O.C.
        • et al.
        Differential effects of transforming growth factor-b1 on cellular proliferation in the developing prostate.
        Endocrinology. 2004; 145: 4292
        • Wilson J.D.
        The critical role of androgens in prostate development.
        Endocrinol Metab Clin North Am. 2011; 40: 577
        • Borchert G.H.
        • Melegos D.N.
        • Tomlinson G.
        • et al.
        Molecular forms of prostate-specific antigen in the serum of women with benign and malignant breast diseases.
        Br J Cancer. 1997; 16: 1087
        • Breul J.
        • Pickl U.
        • Schaff J.
        Extraprostatic production of prostate-specific antigen is under hormonal control.
        J Urol. 1997; 157: 212
        • Katsaros D.
        • Melegos D.N.
        • Diamandis E.P.
        Prostate-specific antigen production by breast tumors after induction with oral contraceptives.
        Clin Biochem. 1998; 31: 285
        • Goh V.H.
        Breast tissues in transexual women-a nonprostatic source of androgen upregulated production of prostate-specific androgen.
        J Clin Endocrinol Metab. 1999; 84: 3313
        • Escobar-Morale H.F.
        • Serrano-Gotarredona J.
        • Garcia Robles R.
        • et al.
        Lack of an ovarian function influence on the increased adrenal androgen secretion present in women with functional ovarian hyperandrogenism.
        Fertil Steril. 1997; 67: 654
        • Escobar-Morreale H.
        • Pazos F.
        • Potau N.
        • et al.
        Ovarian suppression with triptorelin and adrenal stimulation with adrenocorticotropin in functional hyperadrogenism: role of adrenal and ovarian cytochrome P450c17 alpha.
        Fertil Steril. 1994; 62: 521
        • Escobar-Morreale H.F.
        • Serrano Gotarredona J.
        • García-Robles R.
        • et al.
        Mild adrenal and ovarian steroidogenic abnormalities in hirsute women without hyperandrogenemia: does idiopathic hirsutism exist?.
        Metabolism. 1997; 46: 902
        • Guzick D.
        Polycystic ovary syndrome: symptomatology, pathophysiology, and epidemiology.
        Am J Obstet Gynecol. 1998; 179: 89
        • Zarghami N.
        • Grass L.
        • Sauter E.R.
        • et al.
        Prostate specific antigen levels in serum during the menstrual cycle.
        Clin Chem. 1862; 1997: 43
        • Aksoy H.
        • Akcay F.
        • Umudum Z.
        • et al.
        Changes of PSA concentrations in serum and saliva of healthy women during the menstrual cycle.
        Ann Clin Lab Sci. 2002; 32: 31
        • Escobar-Morale H.F.
        • Serrano-Gotarredona J.
        • Avila S.
        • et al.
        The increased circulating prostate-specific antigen concentrations in women with hirsutism do not respond to acute changes in adrenal or ovarian function.
        J Clin Endocrinol Metab. 1998; 83: 2580
        • Utiger R.D.
        Insulin and the polycystic ovary syndrome.
        N Engl J Med. 1996; 335: 657
        • Giudice L.C.
        • van Dessel H.J.
        • Cataldo N.A.
        • et al.
        Circulating ovarian IGF binding proteins: potential roles in normo-ovulatory cycles and in polycystic ovary syndrome.
        Prog Growth Factor Res. 1995; 6: 397
        • Apter D.
        • Butzow T.
        • Laughlin G.A.
        • et al.
        Metabolic features of polycystic ovary syndrome are found in adolescent girls with hyperandrogenism.
        J Clin Endocrinol Metab. 1995; 80: 2966
        • Harris M.I.
        • Hadden W.C.
        • Knowler W.C.
        • et al.
        Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20-74 yr.
        Diabetes. 1997; 36: 523
        • Quintana B.
        • Chinchilli V.
        • Sieber J.
        • et al.
        High risk of glucose intolerance (GI) in women with oligomenorrhea (oligo) or with polycystic ovary syndrome (PCOS).
        1995 (Program of the 77th Annual Meeting of The Endocrine Society, Washington DC, (Abstract OR3–5:50))
        • Bergh C.
        • Carlsson B.
        • Olsson J.H.
        • et al.
        Regulation of androgen production in cultured human theca cells by insulin-like growth factor I and insulin.
        Fertil Steril. 1993; 59: 323
        • Cara J.F.
        Insulin-like growth factors, insulin-like factor binding proteins and ovarian androgen production.
        Horm Res. 1994; 42: 49
        • van Dessel H.J.
        • Lee P.D.
        • Faessen G.
        • et al.
        Elevated serum levels of free insulin-like growth factor I in polycystic ovary syndrome.
        J Clin Endocrinol Metab. 1999; 84: 3030
        • Dunaif A.
        Insulin resistance and the polycystic ovary syndrome: mechanism and implications in pathogenesis.
        Endocr Rev. 1997; 18: 774
        • Nestler J.E.
        Role of hyperinsulinemia in the pathogenesis of the polycystic ovary syndrome and clinical implications.
        Semin Reprod Endocrinol. 1997; 15: 111
        • Bach L.A.
        • Rechler M.M.
        Insulin-like growth factor binding proteins.
        Diabetes Rev. 1995; 3: 38
        • Morales A.J.
        • Laughlin G.A.
        • Bützow T.
        • et al.
        Insulin, somatotropic, and luteinizing hormones axes in lean and obese women with polycystic ovary syndrome: common and distinct features.
        J Clin Endocrinol Metab. 1996; 81: 2854
        • Cohen P.
        • Peehl D.M.
        • Graves H.C.
        • et al.
        Biological effects of prostate specific antigen as an insulin-like growth factor binding protein-3 protease.
        J Endocrinol. 1994; 142: 407
        • Obiezu C.V.
        • Giltay E.J.
        • Magklara A.
        • et al.
        Serum and urinary prostate-specific antigen and urinary human glandular kallikrein concentration are significantly increased after testosterone administration in female-to-male transsexuals.
        Clin Chem. 2000; 46: 859