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Prostate-Specific Antigen and Human Glandular Kallikrein 2 Are Markedly Elevated in Urine of Patients with Polycystic Ovary Syndrome

Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, and Department of Laboratory Medicine and Pathobiology (C.V.O., A.M., A.S., E.P.D.), University of Toronto, Toronto, Canada M5G 1X5; and Department of Obstetrics and Gynecology (M.H.T., C.Y.W., F.Z.S.), University of Southern California School of Medicine, Los Angeles, California 90033

Address all correspondence and requests for reprints to: E. P. Diamandis, M.D., Ph.D., FRCPC, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5. E-mail: ediamandis{at}mtsinai.on.ca

Prostate-specific antigen (PSA) is a well-established tumor marker of prostatic adenocarcinoma. Human glandular kallikrein 2 (hK2), another serine protease closely related to PSA, is also gaining ground as a promising diagnostic tool in prostate cancer. The expression of these 2 proteases is known to be regulated by androgens and progestins in hormonally responsive tissues, such as the male prostate and the female breast. Previously, we have shown that serum PSA levels in normal women are very low but still detectable by ultrasensitive PSA immunoassays. We have also demonstrated that some women with hyperandrogenic syndromes have elevated serum PSA levels. In this study, we have measured urinary PSA and urinary hK2 levels in 35 polycystic ovary syndrome (PCOS) patients and compared them to those of 41 age-matched controls. We found that urinary PSA levels were significantly higher (P < 0.0001) in PCOS patients (mean ± SE = 820 ± 344 ng/L) than in the controls (mean ± SE = 4.3 ± 1.8 ng/L). Similarly, the difference between urinary hK2 of patients (mean ± SE = 8.2 ± 3.1 ng/L) and controls (0.5 ± 0.3 ng/L) was also significant (P < 0.001). A weak correlation was observed between urinary PSA and serum 3-androstanediol glucuronide (r_s = 0.42, P = 0.03) as well as between urinary PSA and serum testosterone (r_s = 0.40, P = 0.04). The results of this study indicate that urinary PSA, and possibly urinary hK2, are promising markers of hyperandrogenism in females suffering from PCOS.