Correlation between Serum Prostate Specific Antigen, Testosterone, and Gleason Score in Men: Implications for Biochemical Grading of Prostate Carcinoma

Abstract

Background: The Gleason grading system is the gold standard for assessing prostate cancer aggressiveness. Whether serum Prostate Specific Antigen (PSA) and testosterone can predict histological grade remains debated, with limited data from West African populations. Aim: The study aims to determine the correlation between serum PSA and Gleason score, and between serum testosterone and Gleason score, in men with histologically confirmed prostate carcinoma. Methods: This study analysed data from 45 Nigerian men with histologically confirmed prostate adenocarcinoma enrolled consecutively at a tertiary hospital over two years. Pearson's correlation coefficient examined associations between serum PSA (ng/mL), serum testosterone (nmol/L), and Gleason score. Subgroup analyses explored patterns across Gleason grade groups. Results: Among the 45 men with histologically confirmed prostate carcinoma, serum PSA showed a weak, non-significant negative correlation with Gleason score (r = -0.283; p = 0.059). The coefficient of determination (r² = 0.080) confirms that PSA explained only 8% of histological grade variability. Serum testosterone performed even more poorly (r = -0.088; p = 0.566; r² = 0.008), accounting for less than 1% of Gleason score variance. Subgroup analysis across grade groups revealed no consistent directional pattern for either biomarker. Neither PSA nor testosterone predicted histological tumour grade reliably in this West African cohort. Conclusion: Serum PSA and testosterone do not reliably predict Gleason score in men with prostate carcinoma. Histopathological evaluation remains indispensable for tumour grading. These findings highlight the limitations of circulating biomarkers in assessing tumour differentiation and underscore the importance of biopsy-based grading in African clinical settings.