Prostate-specific antigen (PSA) levels in men with Prader-Willi syndrome.

Median PSA levels in testosterone-treated men with PWS were low at baseline.

• Retrospective case study of seven men with genetically verified PWS and testosterone-treated hypogonadism
• Median age was 46 years
• Median PSA was 0.68 μg/L (range 0.23-1.3)
• Median testosterone level was 15 nmol/L
• Five men were treated with intramuscular testosterone undecanoate; two had no hypogonadism

Long-term testosterone replacement did not result in clinically meaningful increases in PSA levels.

• Long-term follow-up of PSA was accessible in four patients
• After a median time of 17 years of testosterone replacement, median PSA was 0.75 μg/L (range 0.46-1.4)
• PSA levels remained low throughout the follow-up period
• The change from baseline median PSA (0.68 μg/L) to follow-up (0.75 μg/L) was not considered clinically meaningful

Testosterone replacement therapy was well tolerated with no major behavioral changes reported.

• Medical records were reviewed for adverse effects
• No major behavioral changes were reported in any of the seven men
• Testosterone replacement was described as 'well tolerated'
• The authors conclude testosterone replacement 'is neither associated with serious adverse events regarding changes in behavior or effect on PSA'

The majority of patients in the cohort had also received long-term growth hormone treatment.

• Five of the seven men were treated with growth hormone for more than 20 years
• PWS is characterized by hormone deficiencies including growth hormone deficiency
• The concurrent use of growth hormone was noted as part of the clinical context

Knowledge on potential long-term side effects of testosterone replacement in PWS, particularly on behavior and PSA, is limited.

• Hypogonadism is common in PWS but evidence on testosterone replacement side effects is limited
• The study was a retrospective case series of only seven men, limiting generalizability
• The authors note that 'larger studies are needed to confirm our results'
• PWS is a rare genetic disorder, making large study populations difficult to obtain