Serum PSA level in prostatic lesions with histopathological correlation in Gujarat.

ABSTRACT

Background: Prostate specific antigen (PSA) has been widely used in the diagnosis and management of patients with prostate cancer. It may be elevated in other prostatic diseases and surgical procedures. PSA exists in two forms, a major bound form (cPSA) and a free form (fPSA). Objectives: The objective of the study was to determine the relationship between serum fPSA levels and histologic findings in biopsy specimens of men with prostatic disease. Material and methods: This study includes 80 cases of prostatic diseases and 20 controls for the study were taken from the patients admitted in surgical wards with no prostate related complain, in different age were planned for transurethral resection of prostate (TURP). All the cases and controls were evaluated by serum prostate specific antigen level. Results: The median serum fPSA values for control, malignant and nonmalignant lesions were 3.66 ± 0.029 ng/ml, 20.33 ± 0.0106 ng/ml and 6.47 ± 0.8127 ng/ml respectively. Mean serum PSA values in cases of prostatic hyperplasia with or without dysplasia (PIN Prostatic Intraepithelial Neoplasia I to III), prostatitis, well to moderately differentiated adenocarcinoma and poorly differentiated adenocarcinoma were 6.49 ng/ml, 5.35 ng/ml, 18.92 ng/ml and 31.6 ng/ml respectively. Cut off value of serum PSA 4 ng/ml the sensitivity, specifically and positive predictive value were 100 % and 14.28 % respectively while using 10 ng/ml the findings were 77.77 %, 92.95% and 58.33% respectively. Difference is highly significant between control cases and nonmalignant cases, (p < 0.001) as well as between nonmalignant cases and malignant cases (p < 0.001). Conclusions: In cases of prostatic hyperplasia, chronic prostatitis and prostatic malignancy serum fPSA value increases significantly (P < 0.001) above the standard (0 to 4 ng/ml) as compare to control and nonmalignant group. Statistically there is significant difference in serum fPSA values between control cases and non malignant cases as well between nonmalignant cases and malignant cases of prostate, but when serum PSA values are between 4.0 to10.0 ng/ml.