Seminal citrate is superior to PSA for detecting clinically significant prostate cancer

ABSTRACT Purpose: To establish whether the citrate concentration in the seminal fluid ([CITRATE]) measured by means of high-resolution nuclear magnetic resonance spectroscopy (1HNMRS) is superior to the serum prostate-specific antigen (PSA) concentration in detecting of clinically significant prostate cancer (csPCa) in men with persistently elevated PSA. Materials and Methods: The group of patients consisted of 31 consecutively seen men with histological diagnosis of clinically localized csPCa. The control group consisted of 28 men under long-term follow-up (mean of 8.7 ± 3.0 years) for benign prostate hyperplasia (BPH), with persistently elevated PSA (above 4 ng/mL) and several prostate biopsies negative for cancer (mean of 2.7 ± 1.3 biopsies per control). Samples of blood and seminal fluid (by masturbation) for measurement of PSA and citrate concentration, respectively, were collected from patients and controls. Citrate concentration in the seminal fluid ([CITRATE]) was determined by means of 1HNMRS. The capacities of PSA and [CITRATE] to predict csPCa were compared by means of univariate analysis and receiver operating characteristic (ROC) curves. Results: Median [CITRATE] was significantly lower among patients with csPCa compared to controls (3.93 mM/l vs. 15.53 mM/l). There was no significant difference in mean PSA between patients and controls (9.42 ng/mL vs. 8.57 ng/mL). The accuracy of [CITRATE] for detecting csPCa was significantly superior compared to PSA (74.8% vs. 54.8%). Conclusion: Measurement of [CITRATE] by means of 1HNMRS is superior to PSA for early detection of csPCa in men with elevated PSA.

Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with PSA levels between 2. 6 and 10. 0 ng/mL

ABSTRACT Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 - 10.0 ng/mL and its ability to reduce unnecessary biopsies. Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 - 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001). With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies. Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.

Lower Levels of Human MOB3B Are Associated with Prostate Cancer Susceptibility and Aggressive Clinicopathological Characteristics

Mps one binder (MOB) proteins are integral components of signaling pathways that control important cellular processes, such as mitotic exit, centrosome duplication, apoptosis, and cell proliferation. However, the biochemical and cellular functions of the human MOB (hMOB) protein family remain largely unknown. The present study investigated the association between hMOB3B expression and clinicopathological characteristics of prostate cancer (PCa).Study subjects included 137 PCa patients and 137 age-matched benign prostatic hyperplasia (BPH) patients. hMOB3B expression was estimated using real-time PCR and compared with clinicopathological parameters of PCa. hMOB3B mRNA expression was significantly lower in PCa tissues than in BPH control tissues (P or =10 ng/mL), a Gleason score> or =8, and metastatic disease (any T, N+/M+) than in those with low PSA levels, a low Gleason score, and non-metastatic disease (each P<0.05). In conclusion, low levels of hMOB3B are closely associated with aggressive clinicopathologic features in patients with PCa. Our results suggest that hMOB3B may act as a tumor suppressor in human PCa.

Obesity may influence the relationship between sex hormones and lower urinary tract symptoms

PurposeThe effects of serum testosterone in the lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) are not well established. The objective of the study is to evaluate the association of sex hormones with LUTS and control the results by patient weight.Materials and MethodsThe study comprised a cross-sectional analysis of 725 men included in a prostate cancer screening program at University of Sao Paulo Medical School. The serum concentrations of total testosterone (TT), free testosterone (FT) and sex hormone binding globulin (SHBG) were measured. Variables analyzed were age, American Urological Association (AUA) symptom score, storage symptoms, voiding symptoms, quality of life score, prostate specific antigen levels and prostate volume. Obesity was measured through the calculation of body mass index (BMI). A regression analysis model was performed.ResultsMedian patient age was 65 years (48 to 94). A higher TT level was significantly associated with a severe AUA symptom score only among patients with a BMI ≥ 25. Median TT was 371, 370 and 427ng/dL (p = 0.017) in patients with mild, moderate and severe LUTS respectively. The multivariate regression analysis in patients with BMI ≥ 25 showed that only age, TT and sex score were related to LUTS.ConclusionsA higher TT is associated with a severe AUA score symptom index only in obese patients. Further analysis are necessary to evaluate the mechanisms through which testosterone may influence LUTS in these patients.

Correlation of hepatitis C and prostate cancer, inverse correlation of basal cell hyperplasia or prostatitis and epidemic syphilis of unknown duration

PURPOSE: The accuracy of prostate specific antigen (PSA) to detect prostate cancer has not yet been determined. Autopsy evidence suggests one-third of men have evidence of prostate cancer. Correlation between prostate cancer and sexually transmitted infection is indeterminate. MATERIALS AND METHODS: A retrospective database was created of all men who underwent transrectal ultrasound guided prostate biopsy over 3 years. Men were 49 percent African or African Caribbean, and 51 percent Central or South American. Information about prostate specific antigen, cholesterol, hepatitis A, B and C, human immunodeficiency virus, syphilis, tuberculin skin testing and histology were collected. RESULTS: Hepatitis C antibody detection correlated with prostate cancer OR 11.2 (95 percent CI 3.0 to 72.4). The odds of prostate cancer increased annually (p = 0.0003). However, no correlation was found between prostate cancer and the following: PSA, biopsy date, repeat biopsy, more than 12 cores at biopsy, total cholesterol, high density lipoprotein, triglycerides, low density lipoprotein, risk measure reported with free and total PSA, hepatitis B surface antibody, high grade prostatic intraepithelial neoplasia or atypical small acinar proliferation. Histologic prostatitis and basal cell hyperplasia were inversely correlated with prostate cancer. Syphilis of unknown duration occurred in 17 percent of men with indeterminate correlation to prostate cancer. CONCLUSION: In inner city men of African and African-Caribbean, or Central and South American descent, prostate specific antigen levels did not correlate with prostate cancer. Hepatitis C antibody detection correlates significantly with prostate cancer. One prostate biopsy is sufficient to diagnose statistically significant prostate cancer. Histologic prostatitis and basal cell hyperplasia decrease odds of prostate cancer. Atypical small acinar proliferation may not correlate to prostate cancer and is pending further investigation. Men should be screened for epidemic syphilis of unknown duration.

Transurethral resection of prostate: a comparison of standard monopolar versus bipolar saline resection

INTRODUCTION: Transurethral resection syndrome is an uncommon but potentially life threatening complication. Various irrigating solutions have been used, normal saline being the most physiological. The recent availability of bipolar cautery has permitted the use of normal saline irrigation. MATERIAL AND METHODS: In a randomized prospective study, we compared the safety and efficacy of bipolar cautery (using 0.9 percent normal saline irrigation) versus conventional monopolar cautery (using 1.5 percent glycine irrigation). Pre and postoperative hemoglobin (Hb) and hematocrit values were compared. Hemodynamics and arterial oxygen saturation were monitored throughout the study. Safety end points were changes in serum electrolytes, osmolarity and Hb/PCV (packed cell volume). Efficacy parameters were the International Prostate Symptom Score (IPSS) and Qmax (maximum flow rate in mL/sec) values. RESULTS: Mean preoperative prostate size on ultrasound was 60 ± 20cc. Mean resected weight was 17.6 ± 10.8 g (glycine) and 18.66 ± 12.1 g (saline). Mean resection time was 56.76 ± 14.51 min (glycine) and 55.1 ± 13.3 min (saline). The monopolar glycine group showed a greater decline in serum sodium and osmolarity (4.12 meq/L and 5.14 mosmol/L) compared to the bipolar saline group (1.25 meq/L and 0.43 mosmol/L). However, this was not considered statistically significant. The monopolar glycine group showed a statistically significant decline in Hb and PCV (0.97 gm percent, 2.83, p < 0.005) as compared to the bipolar saline group (0.55 gm percent and 1.62, p < 0.05). Patient follow- up (1,3,6 and 12 months postoperatively) demonstrated an improvement in IPSS and Qmax in both the groups. CONCLUSION: We concluded that bipolar transurethral resection of prostate is clinically comparable to monopolar transurethral resection of prostate with an improved safety profile. However, larger number of patients with longer follow up is essential.

Accurate cut-off point for free to total prostate-specific antigen ratio used to improve differentiation of prostate cancer from benign prostate hyperplasia in Iranian population

Our aim was to determine a more predictive cut-off value for free to total prostate-specific antigen ratio [f/tPSA] to better differentiate prostate cancer [PCa] from benign prostate hyperplasia [BPH] in Iranian patients with serum PSA levels between 4 and 20 ng/mL. This study was performed on 332 men with serum tPSA level of 4 to 20 ng/mL. All patients underwent transrectal ultrasound guided biopsies. Serum levels of tPSA and fPSA were measured by Roche immunoassay Elecsys 2010. Relationship between f/tPSA and cases of PCa was determined. Prostate cancer detected in 49 [15%] patients. Incidence of PCa for serum tPSA level < l0ng/mL and serum tPSA level of 10.1 to 20 ng/ mL was 17 [6.7%] and 32 [39.5%], respectively. Mean f/tPSA value was significantly lower in PCa patients [0.12 +/- 0.01] than in benign histology group [0.16 +/- 0.03]. Among patients with serum PSA level of 4 to 10 ng/mL [n = 251], mean f/tPSA in benign histology group [n = 234] was 0.16 +/- 0.08 and in PCa group [n = 17] was 0.13 +/- 0.06 [P < .05]. For serum PSA level of 10.1 to 20 ng/mL [n = 81], mean f/tPSA in benign histology group [n = 49] was 0.16 +/- 0.08 and in PCa group [n = 32] was 0.12 +/- 0.05 [P < .05]. The cut-off value of 0.12 produced 76% sensitivity and 71% specificity, whereas the cut-off value of 0.14 yielded 83.5% sensitivity and 61% specificity. Determination of f/tPSA ratio improves differentiation of Pea from BPH. We recommend a cut-off value of 0.14 to be applied to Iranian patients

Transurethral resection of the prostate for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia: how much should be resected?

Objective: To assess the impact of the percent of resected tissue on the improvement of urinary symptoms. Materials and methods: The study included a prospective analysis of 88 men with benign prostatic hyperplasia. Patients were divided in three groups according to the percent of resected tissue: Group 1 < 30 percent; Group 2, 30 percent to 50 percent; and Group 3, > 50 percent. Each patient was re-evaluated 3 months after surgery. We assessed the international prostatic symptom score, nocturia and serum prostate specific antigen levels. Results: All patients presented a significant decrease on mean International Prostate System Score (IPSS) (23 to 5.9), Quality of Life (QoL) (4.9 to 1.0) and nocturia (3.2 to 1.9). Variation in the IPSS was 16.7, 16.6 and 18.4 for patients from Group 1, 2 and 3 respectively (P = 0.504). Although the three groups presented a significant decrease in QoL, patients in Group 3 presented a significantly greater decrease when compared to Group 1. Variation in QoL was 3.1, 3.9 and 4.2 for patients from Group 1, 2 and 3 respectively (p = 0.046). There was no significant difference in nocturia variation according to the percent of resected tissue (p = 0.504). Median pre and postoperative PSA value was 3.7 and 1.9 ng/mL respectively. Patients from Group 1 did not show a significant variation (p = 0.694). Blood transfusions were not required in any group. Conclusions:Resection of less than 30 percent of prostatic tissue seems to be sufficient to alleviate lower urinary tract symptoms related to benign prostate hyperplasia. However, these patients may not show a significant decrease in serum PSA level.

The effects of lovastatin on conventional medical treatment of lower urinary tract symptoms with finasteride

OBJECTIVE: To explore whether or not statins have any impact on the progression of components of benign prostatic hyperplasia (lower urinary tract symptoms severity, prostate volume and serum prostate specific antigen (PSA) when combined with other agents inhibiting growth of prostate cells. MATERIALS AND METHODS: This was a preliminary, clinical study. Eligible patients were aged > 50 yrs, with International Prostate Symptom Score (IPSS) between 9 and 19, total prostate volume (TPV) > 40 mL, and serum PSA > 1.5 ng/mL. Patients were divided in two groups: those with and those without lipidemia. After selection, eligible BPH patients with lipidemia (n = 18) were prescribed lovastatin 80 mg daily and finasteride 5 mg daily, while eligible patients without lipidemia (n = 15) were prescribed only finasteride 5 mg daily. IPSS, TPV and serum PSA were evaluated at end point (4 months). RESULTS: There was no difference between the two groups on the primary end point of mean change from baseline in IPSS (p = 0.69), TPV (p = 0.90) and PSA (p = 0.16) after 4 months of treatment. CONCLUSIONS: Short-term lovastatin treatment does not seem to have any effect on IPSS, TPV and PSA in men with prostatic enlargement due to presumed BPH.

Prostate specific antigen levels following transurethral resection of the prostate

OBJECTIVE: Determine how serum prostate-specific antigen (t-PSA) levels and free PSA (f/t PSA) ratio change following transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Thirty men with a mean age of 67.0 + 4.2 years (range 46 to 84 years) underwent TURP for BPH between May 2005 and October 2005. Preoperative assessment included symptom evaluation with the International Prostate Symptom Score (I-PSS) and the prostate volume estimation by transrectal ultrasound. Total PSA and f/t PSA ratio were assessed before the procedure, as well as 30, 60 and 180 days after the TURP. RESULTS: Clinical improvement after TURP, reflected by I-PSS score, was demonstrated as early as 30 days and remained stable until the end of the follow-up. Mean t-PSA declined 71 percent after TURP and 60 days after surgery the reduction reached its peak, stabilizing afterwards. It varied from 6.19 + 7.06 ng/mL before surgery to 1.75 + 1.66 ng/mL on day 60 (p < 0.001). The mean baseline f/t PSA ratio was 18.2 percent + 3.4 percent and was not significantly changed at any given time point in the postoperative period (p = 0.91). There were also no statistically significant differences in t-PSA or f/t PSA between patients with and without prostatitis at any time point (p = 0.23). Resected prostate fragments weighed 29.9 + 19.6 g, corresponding to 39.1 percent of the estimated preoperative prostate volume. Each gram of tissue resected decreased PSA by 0.15 + 0.11 ng/mL, while 1 percent prostate volume resected led to a reduction of 2.4 percent + 0.4 percent in serum PSA from baseline. CONCLUSIONS: PSA decreases drastically in patients who undergo TURP. These low levels stabilize within 60 days after surgery. The f/t PSA ratio did not change, and the finding of chronic prostatitis did not affect the levels of these variables.

Oxidative stress in benign prostate hyperplasia.

Benign Prostate Hyperplasia (BPH) is the common health problem in ageing male. Free radicals and reactive oxygen species (ROS) are produced more with advancement of age leads to oxidative stress. This study aims to assess Malondialdehyde (MDA), the marker of lipid peroxidation and vitaminic antioxidants e.g. alpha-Tocopherol (Toc) and Ascorbate (Asc) status in plasma of BPH patients. This is a case control study conducted in Department of Biochemistry in collaboration with Dept of Surgery, BPKIHS. Forty eight (n = 48) confirmed patients of BPH and forty six (n = 46) healthy age matched controls were enrolled. Plasma MDA, Asc and alpha-Toc were estimated. Plasma MDA level showed 4.81 +/- 1.87 nmol/ml in BPH patients compared to 3.69 +/- 1.56 nmol/ml in healthy controls (p < 0.001). There were significant decrease in plasma alpha-Toc and Asc level which were 0.85 +/- 0.12 mg/dl and 0.93 +/- 0.13 mg/dl in BPH patients compared to 1.37 +/- 0.31 mg/dl and 1.44 +/- 0.38 mg/dl in healthy controls respectively. Inverse correlation of plasma MDA with a- Toc (r = -0.09) and Asc (r = -0.51) was found in BPH patients. There was mild elevation of PSA in BPH patients compared with control but was not statistically significant. Thus, our study showed the evidence of association of oxidative stress in BPH patients.

Antioxidant enzyme activities and lipid peroxides in erythrocytes in patients with benign prostate hyperplasia and prostate cancer

To investigate the possible alteration of oxidant-antioxidant status in the erythrocytes of patients with benign prostate hyperplasia and prostate cancer. Malondialdehyde [MDA], an index of lipid peroxidation, the enzyme activities of superoxide dismutase [SOD], glutathione peroxidase [GPx], glutathione S-transferases [GSTs], catalase [CAT] and reduced glutathione [GSH] levels were estimated in the erythrocytes of 30 prostate cancer [PC] patients, 35 benign prostate hyperplasia [BPH] patients and 28 age-and sex-matched healthy controls. MDA level and GSTs activity levels were significantly increased, while GPx, SOD activities and the level of reduced GSH concentration were significantly decreased in the prostate cancer group versus controls [p<0.001] and BPH group [p<0.05]. The relatively higher GSTs activity and low level of reduced GSH may be due to the response of increased reactive oxygen metabolites production in the blood. The higher MDA level and lower GPx and SOD activities may be inadequate to detoxify high levels of H[2]O[2] into H[2]O leading to the formation of [asterisk]OH radical followed by the formation MDA. Oxidant-antioxidant imbalance may be one of the major factors responsible for the development of prostate cancer and benign prostate hyperplasia

Normal serum prostate specific antigen levels in men in Yasuj province, Islamic Republic of Iran

We assessed serum prostate specific antigen [PSA] levels in 650 men over 40 years referred to 3 Yasuj hospitals for blood cell count in 2003/2004. Men affected by prostate cancer, prostatitis or transurethral instrumentation were excluded. PSA was determined by an immunoassay technique. PSA levels in different age groups were: 40-49-year-olds-mean = 0.7 ng/dL, normal = 0-1.35 ng/dL; 50-59-year-olds-mean = 0.9 ng/dL, normal = 0-1.85 ng/dL; 60-69-year-olds-mean = 1.6 ng/dL, normal = 0-3.2 ng/dL; >/= 70-years-olds-mean = 2.3 ng/dL, normal = 0-4.4 ng/dL. Normal PSA levels in our society were lower than those in the United States, Europe and Japan

Effect of the consumption of tomato paste on plasma prostate-specific antigen levels in patients with benign prostate hyperplasia

The consumption of tomatoes and tomato products has been associated with a reduced risk of prostate cancer. We observed a decrease of 10.77 percent in prostate-specific antigen (PSA) levels in patients with benign prostate hyperplasia who were submitted to daily ingestion of tomato paste. This was an experimental rather than a controlled study with a sample of 43 men ranging in age from 45 to 75 years, all with histological diagnoses of benign prostate hyperplasia and plasma PSA levels of 4-10 ng/mL. All patients received 50 g of tomato paste once a day for 10 consecutive weeks and PSA levels were analyzed before, during and after the consumption of tomato paste. ANOVA for repeated measures was used to compare PSA levels before, during and after the consumption of tomato paste. The mean ± SD PSA level was 6.51 ± 1.48 ng/mL at baseline and 5.81 ± 1.58 ng/mL (P = 0.005) after 10 weeks. Acceptance was good in 88.3, regular in 9.3, and poor in 2.3 percent of the patients. Dietary ingestion of 50 g of tomato paste per day for 10 weeks significantly reduced mean plasma PSA levels in patients with benign prostate hyperplasia, probably as a result of the high amount of lycopene in tomato paste. This was not a prostate cancer prevention study, but showed some action of tomato paste in prostate biology. The development of prostate cancer is typically accompanied by an increase in plasma PSA levels, thus any intervention that affects plasma PSA levels can suggest an impact in the progression of disease.

Role of free to total prostate specific antigen ratio in serum in the diagnosis of prostatic enlargement.

This study was aimed to demonstrate the significance of free/total Prostate Specific Antigen (PSA) ratio in the diagnosis of prostatic enlargement. The study was carried out in a total number of 100 subjects, of which 58 had benign prostatic hyperplasia (BPH), 42 had carcinoma prostate and 50 were age matched control. The subjects were collected from Dhaka Medical College Hospital (DMCH) and Bangabandhu Sheikh Mujib Medical University (BSMMU). Venous blood (5ml) was drawn from each subject before digital rectal examination or pre-urethral manipulation for estimation of PSA. Final diagnosis was made by histopathological examination, specimen being obtained by transurethral resection of prostate (TURP), open prostatectomy and per rectal tru-cut biopsy with biopsy gun. The study showed a highly significant difference of serum PSA and free/total PSA ratio in differentiating BPH from carcinoma prostate. Free/total PSA ratio was highly significant in differentiating between BPH and carcinoma prostate (p<0.001) and carcinoma prostate and control (p<0.001). In the marginally elevated PSA, free/total PSA ratio reduced biopsy by 81-85% in BPH and carcinoma prostate respectively. The overall specificity, positive predictive value and efficiency of free/total PSA was much higher than that of total PSA in differentiating BPH from carcinoma prostate.

Diagnosis of malignancy of prostate.

Minimal or complete lack of symptoms hinders early diagnosis of malignancy of prostate leading to undue morbidity and mortality. Therefore early detection is imperative, making use of simple and safe technique with least of expense. Five hundred consecutive patients, who reported with urinary complaints, were assessed by digital rectal examination, transabdominal suprapubic ultrasonography for prostatic volume/weight and serum assay of prostate specific antigen (PSA). Histopathological examination of prostatic biopsy of all the cases was also done. Benign prostatic hyperplasia was found in 83.6% of cases and 16.4% of the cases were of adenocarcinoma prostate of varying severity (mild, moderate and severe). It was found that volume/weight of gland and PSA levels were very good indicators of the probable diagnosis and grade of adenocarcinoma. Statistical tests taking various levels of PSA values in account also validated the results.

Free and total prostate specific antigen in benign prostate hyperplsia and prodtate cancer

To record the levels of PSA in the sera of prostate cancer [CaP] and benign prostatic hyperplasia [BPH] cases. Free PSA/total PSA as percentage was also calculated in order to evaluate its utility in differentially diagnosing BPH and CaP. Design: A cross-sectional, case control study. Place and Duration of Study: Shaikh Zayed Hospital and Mayo Hospital, Lahore from August 2002 to March 2003. Materials and A group of 108 male subjects, including one-third of each of biopsy-confirmed prostate cancer cases, BPH cases and asymptomatic controls of matching age were studied. PSA and Free PSA were determined by ELISA using commercially available assay kits. Mean PSA was found to be highest in CaP cases [41.9 + 38.7 ng/ml], lower in the BPH cases [13.5+10.5 ng/ml], while it was lowest in the control subjects [5.7 + 4.4 ng/ml]. Moreover, it was observed that a majority of the CaP cases had serum PSA >20 ng/ml, 50% of BPH cases had serum PSA in the 'gray zone' [4.1-20 ng/ml], while majority of controls had serum PSA in the 'normal' range [0 - 4 ng/ml]. Using a free-PSA "cut-off" of 18% to differentiate between benign and malignant prostate enlargement, it was found that 80% of the CaP cases had F/T% <18, while 75% of the BPH cases had F/T%>18. The percent free-PSA test to differentially diagnose BPH and CaP in the 'gray zone' was found to have a sensitivity of 86% and a specificity of 94%. Using a cutoff of 18%, the free-PSA test significantly improved the differential diagnosis of BPH and CaP in the 'gray zone' as compared to the use of total PSA alone in the study group

Inflammation and glandular proliferation in hyperplastic prostates: association with prostate specific antigen value.

A series of 73 cases of surgically resected prostatic tissue were histologically diagnosed as nodular hyperplasia, of which 10 (13.69%) cases had chronic prostatitis. The mean value of prostate specific antigen in prostatic hyperplasia without chronic prostatitis and prostatic hyperplasia with chronic prostatitis were 6.09 ng/ml and 13.61 ng/ml respectively. A statistically significant difference of prostate specific antigen level between these two groups were noted (P<.05). The degree of glandular proliferation in nodular hyperplasia was subjectively assessed and was recorded as mild, moderate or severe degree of proliferation. The mean value of prostate specific antigen were 3.28 ng/ml in patients with mild proliferation, 7.21 ng/ml in those with moderate proliferation and 14.78 ng/ml in those with severe proliferation. A significant association between prostate specific antigen level and degree of glandular proliferation was found (P<.05). Chronic prostatitis and glandular proliferation are the two important factors contributing to serum prostate specific antigen elevation in hyperplastic prostates.

The usefulness of prostate specific antigen density as a screening method for prostatic carcinoma.

Prostate specific antigen (PSA) has been used extensively for monitoring the progression of prostatic cancer since its discovery in 1979. Unfortunately the measurement of PSA in serum is not sufficiently specific for early detection of prostatic carcinoma (CaP) as it is secreted by normal as well as hyperplastic or cancerous prostatic tissue. As serum PSA is the reflection of the number of prostatic epithelial cells, a small cancerous prostate gland having increased number of cells per unit volume leaks more PSA in serum than a benign, large gland. Thus the concept of PSA density (PSAD) has been proposed (the quotient of serum PSA divided by the volume of prostate in cubic centimeter) as an indicator for prostatic malignancy. In the present study pre-operative PSAD values of 65 cases of prostatic diseases were calculated [54 cases of benign prostatic hyperplasia (BPH) and 11 cases of C3P]. Serum PSA was measured by enzyme linked immunosorbent assay (ELISA) method and the prostatic volume was measured by transrectal ultrasonography (TRUS). Although 8 cases of BPH (14.8%) had raised PSA level, abnormal PSAD (0.1 or above) was noted in only 3 cases. All cases having PSAD value above 0.2 had carcinoma. The PSAD value above 0.1 in cases of CaP was found to be significant (p<0.001). By using PSAD as screening test the sensitivity increased from 85.1% to 94.4% and positive predictive value increased from 55.5% to 75%, compared to the detection of carcinoma by measuring PSA alone. The present study concludes that PSAD is more useful for prediction of CaP and the need of prostatic biopsy for early detection.

Câncer de próstata: correlaçäo entre biópsias guiadas por ultra-sonografia transretal e PSA / Cancer of prostate: correlation between biopsys guided by transrectal ultrasound

O objetivo do estudo é correlacionar o diagnóstico e o estadiamento patológico final de câncer de próstata através da combinaçäo entre os níveis séricos de PSA(Antígeno Prostático Específico) e biópsias prostáticas guiadas ultra-sonograficamente. Foram revisados 348 prontuários de pacientes submetidos a biópsias prostáticas guiadas por ultra-som no período compreendido entre 25 de fevereiro de 1993 até 4 de junho de 1998. A ocorrência de adenocarcinoma isolado foi de 32,2 por cento )p<0,005) e, quando associado a outras patologias, atingiu 48,9 por cento da amostra. Níveis de PSA "bordeline" (4.1 - 10.0) ng/ml) mostraram predomínio significante de Hiperplasia Prostática Benigna (HPB), com 47 por cento dos indivíduos (p<0,001), embora houvesse adenocarcinoma em 40,9 por cento dos pacientes. Em níveis de PSA alterados (maiores que 10,1 ng/ml), a presença de adenocarcinoma era significante, 61,2 por cento (p<0.001). Valores de PSA "bordeline" relacionavam-se a HPB e valores alterados indicavam adenocarcinoma. Neoplasias com escore de Gleason entre 8-10 só foram encontradas em pacientes com altas taxas de PSA, enquanto que em níveis normais (até 4.0 ng/ml) ou "bordeline", houve predomínio de lesöes com escore 2-4