Serum prostate-specific antigen as a tumor marker for its correlation with histopathological diagnosis of prostatomegaly

Abstract

Background: Prostatomegaly is common in men past fifth decade of life and has been the most common cause of symptoms associated with lower urinary tract obstruction. The emergence of prostate-specific antigen (PSA) has come to rescue of clinicians at screening the prostate cancer by its raised value in serum. The further research over the PSA brought out few new indices which are sensitive in screening and suggesting prostate cancer such as the ratio between free and bound PSA, PSA density (PSAD), and PSA velocity. Objectives: The objective of this study is (1) to study serum PSA level and PSAD at the differentiation of benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia, and prostatic carcinoma (PCa) established at prostatic tissue diagnoses, (2) evaluation of the significance of total prostate-specific antigen (TPSA) level in the intermediate range of 4–10 ng/ml at assessment of benign versus malignant prostatomegaly at tissue diagnoses, and (3) to draw cutoff values of PSAD (0.15 vs. 0.18 ng/ml/cc) in suggesting benign versus malignant prostatomegaly at tissue diagnoses. Materials and Methods: Digital rectal examination was carried out in suspected clinical cases of prostatomegaly. One hundred and eight cases of prostatomegaly have undergone TPSA estimation prospectively by Vidas TPSA kit. PSAD was calculated as the ratio between TPSA and the volume of the prostate. The sample received for histopathological diagnoses were either sextant biopsy (25 specimens), transurethral resection of prostate (68 specimens), and prostatectomy (15 specimens). Results: TPSA was performed in total 108 patients of prostatomegaly, of which 35 (40.22%) cases had TPSA in the range of ≤4 ng/ml, 37 (34.25%) cases had TPSA in the range of 4.01–10 ng/ml, and 36 (33.33%) cases had TPSA in the range of >10 ng/ml. The mean PSAD cutoff of