Abstract
The discovery that PSA exists in serum in both free and complexed forms led to development of immunoassays specific for different PSA forms. This helped in measuring free PSA in the presence of PSA-ACT (PSA-α antichymotrypsin), hence it was possible to calculate the percent free PSA or free to total PSA ratio, measurement of which was helpful in reducing the number of unnecessary biopsies significantly, while maintaining a high clinical sensitivity for detection of cancer. The study was performed on 103 consecutive male patients (mean age 68 ± 10.8 years SD) comprising of 90 patients with benign disease (87%) and 13 prostate carcinoma patients (13%), who had histologically proven prostate cancer. Patients with total PSA between 2–25 ng/ml were included in the study. 30 normal healthy males with age 58 ± 10 years, served as control. Serum total PSA and free PSA were analyzed using streptavidin biotin EIA method (M/s Roche Diagnostics, Germany). The mean total PSA in normal healthy control subjects was 1.86 ± 1.07 ng/ml. It was increased significantly in diseased condition. Its mean concentration in carcinoma patients was 12.6 ± 5.3 ng/ml and in benign patients it was 6.3 ± 4.6 ng/ml. The free to total PSA ratio in all the three groups was significantly different (p Combination of this ratio cutoff with other parameters like serum total PSA, DRE and TRUS helped in increasing the sensitivity of the test and this also helped in reducing the number of unnecessary biopsies. In 103 men who were biopsied, 13 (12.6%) prostatic carcinoma were identified. Among these 13 cancer patients, 9 patients had abnormal findings in DRE.7 individuals out of these 9, also had free to total PSA ratio lower than 0.16 and would have been biopsied and diagnosed anyway. If we use only f/t PSA ratio less than 0.16, to decide whom to biopsy, we would have biopsied and diagnosed 11/13 cases i.e. sensitivity of 85% but If we decide to biopsy those patients who had abnormal DRE and those who had low f/t PSA ratio, we could identify 13/13 carcinoma i.e. 100% sensitivity.Combining the f/t PSA ratio with total PSA, DRE and TRUS findings could help in reducing the number of unnecessary biopsies. 37 patients who were negative for malignancy having total PSA in the range of 5–20 ng/ml, normal DRE and TRUS findings, have been biopsied but with combination of total PSA in the range of 5–20 ng/ml, normal findings in digital rectal examination and TRUS and f/t PSA ratio more than 0.16 (cutoff), we could have avoided 16 biopsies which were unnecessary that means there was 43% reduction in unnecessary biopsies.
Highlights
Benign prostatic hyperplasia and prostate cancer, are the two most common forms of prostatic disease found in men beyond the age of 50 years
Prostate specific antigen can be used for effective diagnosis of clinically significant cancer, its use is limited by a number of benign conditions like benign prostatic hyperplasia, prostatitis, aging, prostatic infarction etc. that can cause elevations in serum total prostate specific antigen (PSA)
PSAACT is the predominant serum PSA form measured by immunoassay [8], the PSA- ACT immunoassay using anti PSA monoclonal antibodies for capture and antiACT monoclonal antibodies for detection may be compromised by interference of serum cathepsin GACT complex [9]
Summary
Benign prostatic hyperplasia and prostate cancer, are the two most common forms of prostatic disease found in men beyond the age of 50 years. Thakur et al / Utility of f/t PSA ratio in diagnosis of prostate carcinoma of onset for both of these diseases is same, they are to be clinically differentiated in early stages for treatment to be most effective [1] In this endeavor, prostate specific antigen (PSA) has become a key tumor marker for screening and early detection of prostate cancer [2]. PSAACT is the predominant serum PSA form measured by immunoassay [8], the PSA- ACT immunoassay using anti PSA monoclonal antibodies for capture and antiACT monoclonal antibodies for detection may be compromised by interference of serum cathepsin G (cG)ACT complex [9] This improved immunoassay has shown minimal improvement in prostate cancer detection as compared to ratio of free PSA to total PSA or percent free PSA. According to Catalona et al, the ratio of free PSA to PSA ACT was not superior to percent free PSA in improving cancer detection specificity [9]
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