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Testosterone, level of the lesion and age are independently associated with prostate volume in men with chronic spinal cord injury

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Abstract

Purpose

Although men with spinal cord injury (SCI) exhibit a prostate volume significantly smaller compared to age-matched able-bodied men, the independent association of lower prostate volume with its putative determinants has never been analyzed in this population. This study was designed to identify variables independently associated with prostate volume in men with chronic SCI.

Methods

In this cross-sectional study, prostate volume of 138 men with chronic (> 1 years) SCI, aged 54.5 (25th–75th percentile: 36.0–66.0) years, was evaluated with trans-rectal ultrasonography. All patients underwent a complete neurological exam, as well as biochemical and hormonal assessment, including total testosterone (TT) levels. Free testosterone levels were calculated (cFT) by the Vermeulen formula.

Results

The median prostate volume was 23.4 mL. At the univariate analysis, a larger prostate volume was associated with higher TT (p = 0.00001) and cFT (p = 0.001), SCI level below T12 (p = 0.007), more advanced age (p = 0.04), lower body mass index (p = 0.04), higher functional independence score (p = 0.06), higher values of prostate-specific antigen (p = 0.12) and shorter duration of the injury (p = 0.21). However, at the multiple regression analyses, an independent and positive association only persisted between the prostate volume with either TT or cFT levels, and, to a lesser extent, with age and a level of spinal lesion below T12. A prostate volume below the median value was observed in 91.4% (32/35) of patients with both androgen deficiency (TT < 264 ng/dL) and spinal lesion level ≥ T12, but only in 16.5% (2/12) of patients with both normal androgen levels and spinal lesion level below T12 (p < 0.001).

Conclusions

Our data indicate that lower testosterone levels and, to a lesser extent, a younger age and a spinal lesion level ≥ T12 represent the only variables exhibiting an independent association with a smaller prostate volume in men with SCI.

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Funding

This work was supported by PRIN 2017, Ministero dell’Università e della Ricerca Scientifica (MIUR), Italy.

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Authors and Affiliations

  1. Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Tommasi 1, 67100, L’Aquila, Italy

    S. D’Andrea, C. Castellini, E. Minaldi, M. Totaro, S. Francavilla, F. Francavilla & A. Barbonetti

  2. Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy

    S. D’Andrea & G. Felzani

Authors
  1. S. D’Andrea
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  2. C. Castellini
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  3. E. Minaldi
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  4. M. Totaro
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  5. G. Felzani
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  6. S. Francavilla
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  7. F. Francavilla
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  8. A. Barbonetti
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Contributions

Conceptualization, methodology and writing—original draft preparation: AB, SDA. Formal analysis and investigation: AB, CC, SDA, EM, MT. Supervision: AB, SF, GF, FF.

Corresponding author

Correspondence to A. Barbonetti.

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All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The local ethics committee approved the study protocol.

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D’Andrea, S., Castellini, C., Minaldi, E. et al. Testosterone, level of the lesion and age are independently associated with prostate volume in men with chronic spinal cord injury. J Endocrinol Invest 43, 1599–1606 (2020). https://doi.org/10.1007/s40618-020-01243-3

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  • DOI: https://doi.org/10.1007/s40618-020-01243-3

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