Comparison of PSA value in patients with PCOS with and without signs of Hirshutism phenotypes

Objective: PCOS is recognized as one of the most common endocrine/metabolic disorders in women. Hirsutism is a clinical manifestation of hyperandrogenemia, which can be seen in 70-80% of patients with PCOS. Although the precise role of PSA in PCOS patients remains to be determined, PSA may serve as a useful clinical marker and may even represent a new diagnostic criterion of hyperandrogenemia in women with PCOS. In our study, patients with PCOS will be categorized as those with and without hirsutism, and the free and total PSA values of the two groups will be compared. If a meaningful result is obtained, the androgen levels of patients with hirsutism diagnosed with PCOS will be followed more closely and the treatment process can be followed more effectively. PSA can be used as a new biochemical marker in the diagnosis, follow-up and treatment management of PCOS. Materials and Methods:The research is a prospective cohort study. The study was carried out on 01/05/2022 and 31/12/2022 in Bilkent City Hospital Gynecology and Obstetrics Clinic. 1. Patients with PCOS diagnosis and hirsutism 2. Control group patients with PCOS diagnosis but without hirsutism Patients aged 19-30 years diagnosed with PCOS according to the Rotterdam 2003 criteria were included in the study. Accordingly, the patients were divided into two groups according to their Ferriman-Gallwey hirsutism scores. Those with a score above 8 were grouped as those with hirsutism, those with a score below 8 were grouped as patients without hirsutism. Inclusion criteria for the study; voluntarily giving consent of the patients, being between the ages of 19-30, having a diagnosis of PCOS. Study exclusion criteria; Being under the age of 18 or over the age of 30, not giving consent, having severe neurological, cardiac, kidney and liver disease, having a diagnosis of complicated DM. Continuous variables were reported as mean, standard deviation (SD), and minimummaximum values, while discrete variables were reported as numbers (percentage). After the normal distribution of continuous variables was controlled by visual evaluation of histograms and the Shapiro-Wilk test, continuous data between the 2 groups were compared with an independent t-test. The relationship between discrete variables was analyzed with the Chisquare test or Fisher's exact test. Statistical analysis was performed with SPSS version 22.0 (IBM, New York, USA) program and p<0.05 was considered statistically significant. Variables: 90 patients who applied to our clinic and were diagnosed with PCOS according to the Rotterdam 2003 criteria, 45 patients with a score above 8 according to Ferriman-Gallwey hirsutism scores were grouped as patients with hirsutism, 45 patients with a score below 8 were grouped as patients without hirsutism, and serum free and total PSA values were evaluated. Free PSA level was higher in those with hirsutism (mean 0.007, SD 0.005), and in those without (mean 0.007, SD 0.005). These results were not statistically significant (p=0.908). Total PSA level was increased in those with hirsutism (mean 0.4, SD 0.1) and in those without (mean 0.4, SD 0.1). These results were not statistically significant (p=0.614). When other laboratory characteristics of both groups were compared, free testosterone levels in those with hirsutism (mean 2.7, SD 1.1) were higher than those without (mean 2.2, SD 0.7), which was statistically significant (p=0.014). Conclusion: We investigated the relationship between hirsutism and high serum PSA levels in women diagnosed with PCOS. In our study, there was no significant difference in free and total PSA values between the patient and control groups. Since there are conflicting results about PSA level in patients with PCOS in the literature, we think that large-scale studies with larger patient and control groups should be performed in order to use PSA as a diagnostic marker in PCOS. In order to better understand the place of serum PSA level in the pathophysiology of PCOS, the scientific literature should be supported by studies to be conducted in larger patient groups. The value of serum PSA measurement in women with hirsutism can be strengthened as a reliable marker of androgen effect in androgen sensitive tissues, but with the increase of studies supporting the relationship with the subject. Keywords: PCOS, PSA, hirsutism