Changes in prostate specific antigen (PSA) with clomiphine citrate: preliminary data on infertile hypogonadal men

Abstract

OBJECTIVE: The effects of testosterone replacement on the initiation of prostate cancer are controversial. Hypogonadal men treated with testosterone replacement are followed with regular PSA and DRE exams during testosterone therapy. Hypogonadal infertile men or men with loss of libido in childbearing age are sometimes treated with clomiphene citrate (CC) to improve libido or sperm concentration. However, the effects of CC on the prostate and PSA are unknown. The objective of this preliminary study was to determine if short term CC therapy affects PSA levels.DESIGN: Patient charts were reviewed over the last two years in those who had PSA testing done either pre/post-CC therapy or post-CC therapy. 15 patients met the inclusion criteria.MATERIALS AND METHODS: Patients were started on CC if they were hypogonadal or had borderline normal testosterone with low/low normal FSH. Testosterone, FSH, LH, prolactin and PSA levels were recorded. PSA testing was done in some but not all cases prior to therapy and all patients post therapy. Semen analysis data were collected.RESULTS: Average pre-therapy testosterone, LH and FSH were 300, 3.34, and 4.68, respectively. PSA testing was done in all patients on an average of 4.6 months post CC therapy. All patients had minimal increases in PSA or had post-CC therapy PSA levels less than 1.8. Average post-therapy PSA was 0.74. FSH levels increased an average of 2.35 ng/dl. Testosterone increased an average of 198 ng/dl.CONCLUSIONS: There were no significant increases in PSA or post-CC therapy PSA measurements were all below 1.8 ng/dl. Preliminary data suggest that clomiphene citrate has no short term effects on PSA levels. OBJECTIVE: The effects of testosterone replacement on the initiation of prostate cancer are controversial. Hypogonadal men treated with testosterone replacement are followed with regular PSA and DRE exams during testosterone therapy. Hypogonadal infertile men or men with loss of libido in childbearing age are sometimes treated with clomiphene citrate (CC) to improve libido or sperm concentration. However, the effects of CC on the prostate and PSA are unknown. The objective of this preliminary study was to determine if short term CC therapy affects PSA levels. DESIGN: Patient charts were reviewed over the last two years in those who had PSA testing done either pre/post-CC therapy or post-CC therapy. 15 patients met the inclusion criteria. MATERIALS AND METHODS: Patients were started on CC if they were hypogonadal or had borderline normal testosterone with low/low normal FSH. Testosterone, FSH, LH, prolactin and PSA levels were recorded. PSA testing was done in some but not all cases prior to therapy and all patients post therapy. Semen analysis data were collected. RESULTS: Average pre-therapy testosterone, LH and FSH were 300, 3.34, and 4.68, respectively. PSA testing was done in all patients on an average of 4.6 months post CC therapy. All patients had minimal increases in PSA or had post-CC therapy PSA levels less than 1.8. Average post-therapy PSA was 0.74. FSH levels increased an average of 2.35 ng/dl. Testosterone increased an average of 198 ng/dl. CONCLUSIONS: There were no significant increases in PSA or post-CC therapy PSA measurements were all below 1.8 ng/dl. Preliminary data suggest that clomiphene citrate has no short term effects on PSA levels.