ABSTRACT
The incidence of Cancer Prostate [PCa] has increased dramatically during the last 10-15 years many strategies have been proposed to enhance the ability of PSA in differentiation of PCa from BPH and f/t PSA was one of those strategies that were reported to improve the diagnostic accuracy of PSA. Of these markers we evaluated prostatic specific antigen [PSA], Neurone specific enolase [NSE], Tissue polypeptide specific antigen [TPS] and Scatter factor [SF], also known as hepatocyte growth factor [HGF]. The present study aimed at evaluating the measurement of serum levels of NSE, TPS and HGF in combination with PSA and I7t PSA in cancer prostate patients to assess their diagnostic and prognostic value in such patients. The study was conducted on 72 patients complaining of obstructive symptoms as frequency and urgency. The first group comprised 26 subjects diagnosed as BPH, the second group consisted of 21 subjects diagnosed as localized PCa and the third group consisted of 25 subjects diagnosed as metastatic PCa. The latter group was further divided according to Gleason score into moderately differentiated [n=13] and poorly differentiated adenocarcinoma [n=12]. All patients were subjected to transrectal ultrasonography [TRUS] and core needle biopsy from the prostate for histopathological examination, and assay of serum tPSA, fPSA measured by chemiluminescent immunometric assay, NSE using electrochemiluminescence immunometric assay, TPS [1RMA] and HGF [ELISA]. Median values of tPSA was significantly higher in metastatic PCa [group III] compared to localized PCa [group II] and BPH patients [group I] [68, 7.0, 2.0ng/ml respectively P<0.001], f/t PSA was significantly lower in PCa patients [group II, group III] compared to BPH patients [0.13, 0.14,0.2 respectively, P=0.004], TPS was significantly higher in metastatic PCa [140U/L] compared to group I and group II [77,65U/L, respectively P=0.004] and HGF was significantly highest in metastatic PCa patients compared to group I and group II [2270, 2132, 1789pg/ml, respectively, P=0.047]. A statistical significant positive correlation was found in the malignant group between PSA and HGF and between [TPS] on one hand and [NSE and HGF] on the other hand. Simultaneous assay of PSA and HGF yielded a sensitivity of 96% in discriminating between BPH from malignant prostate compared to 91% for HGF and 93% for PSA alone. Higher NSE levels were found in higher stage and higher grade PCa. On evaluating the metastatic PCa group, it was found that poor PSA progression free survival [shorter time to androgen responsiveness] is associated with high NSE levels, and with poorly differentiated adenocarcinoma [high Gleason score 8-10]. The value of tPSA in diagnosing cancer prostate is still of uncertainty, however, it is better to be combined with f/tPSA assay. The f/tPSA is useful in discriminating between BPH and PCa especially in the early stage [localized PCa] and thus allowing early intervention and treatment. A cutoff value of 0.24 for f/tPSA is recommended as it detects 87% of cancer cases and at the same time avoids 39% of unnecessary prostate biopsy. Moreover, combining PSA and HGF was more accurate in discriminating between BPH and malignant prostate than either marker alone. HGF alone is of prognostic significance especially in the presence of metastates and correlates well with the stage and grade of cancer prostate. An increase in TPS signifies clinical progression even if PSA is found to remain normal. Thus it is of value in overcoming the relative insensitivity of PSA in some of hormonally treated patients. High NSE levels are of prognostic significance in patients with metastatic PCa treated with androgen withdrawal therapy