Abstract Introduction Prostate cancer ranks as the 2nd most frequently diagnosed malignancy among men, with prostate-specific antigen (PSA) serving as its primary diagnostic biomarker. Growing evidence suggests a potential link between malignancies and obstructive sleep apnea (OSA), the leading sleep disorder besides insomnia. This study aimed to investigate the relationship between serum total PSA concentrations and OSA. Methods A cross-sectional observational study was conducted using data from men aged over 50 years participating in the 4th São Paulo Epidemiological Sleep Study (EPISONO; 769 participants). OSA diagnosis was established through overnight type I polysomnography. The primary endpoint was serum total PSA level. Covariates included age, body mass index (BMI), OSA severity, proportion of total sleep time with oxygen saturation below 90% (T90), and serum concentrations of total testosterone and estradiol. Results The analytical subsample comprised 111 participants, with a mean age of 61.7 years and an average BMI within the overweight classification. After adjustment for BMI and T90, individuals with moderate-to-severe OSA exhibited significantly increased odds of having clinically elevated total PSA levels (≥4.0 ng/mL). Higher estradiol concentrations were inversely associated with total PSA, indicating a potential protective influence, whereas total testosterone showed no significant correlation. These associations remained stable in a sensitivity model excluding T90. Conclusion Moderate-to-severe OSA was independently associated with elevated total PSA levels in men aged over 50 years, emphasizing the relevance of sleep-disordered breathing in prostate cancer screening. Increased estradiol concentrations appeared to mitigate PSA elevation, suggesting a modulatory role of sex hormones. These results reinforce the need to incorporate sleep evaluations into standard clinical assessments to enhance early detection and individualized management. Support (if any) Associação Fundo de Incentivo à Pesquisa (AFIP), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; grants 2020/13467-8 and 2021/05920-7).
Porcacchia et al. (Fri,) studied this question.