Free Prostate-specific Antigen Levels Research Articles

Association Between Smoking Status, and Free, Total and Percent Free Prostate Specific Antigen

There are scant data available on the relationship between smoking and total prostate specific antigen, free prostate specific antigen and percent-free prostate specific antigen. Given the high prevalence of smoking and the frequency of prostate specific antigen screening, it is important to determine any association between smoking and prostate specific antigen values using nationally representative data. Included in the final study population were 3,820 men 40 years old or older who participated in the 2001-2006 NHANES (National Health and Nutrition Examination Survey) and met the eligibility criteria for prostate specific antigen testing. The distributions of total, free and percent free prostate specific antigen were estimated by sociodemographic and clinical characteristics. Multivariate linear regression models were fit to determine the adjusted relationship between smoking and total and percent free prostate specific antigen while simultaneously controlling for these characteristics. For all ages combined the median total and free prostate specific antigen levels were 0.90 (0.81-0.90) and 0.26 (0.25-0.28) ng/ml, respectively. Multivariate linear regression analysis showed that total prostate specific antigen was 7.9% and 12.2% lower among current and former smokers, respectively, than among never smokers. High body mass index and diabetes were also statistically significantly associated with a lower total prostate specific antigen. Approximately a third of the men had a percent free prostate specific antigen less than 25%. Current smokers had a significantly lower percent free prostate specific antigen than former smokers. Our finding that smoking is inversely associated with total prostate specific antigen may have potential implications for the interpretation of prostate specific antigen levels in men who are current or former smokers. Given the high prevalence of smoking, obesity and diabetes, additional research on the combined effect of these health risk factors is warranted.

Ciprofloxacin versus levofloxacin in avoidance of prostate biopsy in patients with isolated PSA elevation: a prospective randomized study

The efficiencies of ciprofloxacin and levofloxacin on prostate-specific antigen (PSA) elevation were compared in terms of avoidance of prostate biopsy in this study. Materials and methods: Included in the study were 43 men with PSA levels of >=3.5 ng/mL. They were randomized into either ciprofloxacin or levofloxacin groups for a 3-week course. PSA and free PSA levels were measured before and after the antibiotherapy. The patients in whom PSA remained >=3.5 ng/mL after therapy underwent biopsy. Results: The average age of the men was 64.44 years (standard deviation: 9.54). Following antibiotics, 76.7% of the patients showed a reduction in PSA and 32.6% showed PSA normalization; PSA levels dropped by a rate of 27.1% (P < 0.001). In the ciprofloxacin group, the PSA reduction rate and PSA normalization were insignificantly higher than in the levofloxacin group. Ciprofloxacin caused a significant reduction in PSA (-41.6% change, P < 0.001), but levofloxacin did not (-5.6% change). With quinolones, positive predictive value improved from 9.3% to 13.8%. Of the 29 patients with persistent PSA levels of >=3.5 ng/mL after antibiotics, 4 were diagnosed with prostate cancer (13.8%). Conclusion: Empirical ciprofloxacin seems to be more effective than levofloxacin in men with isolated PSA elevation, leading to the avoidance of unnecessary prostate biopsy in nearly half of the cases, and enhances diagnostic capabilities of both PSA and prostate biopsy.

Prostate specific antigen levels after acute myocardial infarction.

Prostate Specific Antigen (PSA), a member of kallikrein family, is a specific serine protease of prostatic tissue. In some case reports, changes in PSA levels after acute myocardial infarction (AMI) have been reported. In this study we evaluated variations in PSA levels post-AMI. Twenty-six male patients who had PSA levels within reference limits were included in the study. The diagnosis of AMI was confirmed by clinical findings, ECG (electrocardiogram) and cardiac marker studies. Serum total PSA (tPSA) and free PSA (fPSA) levels were measured at days 0 (day of admission), 1, 2 and 3 after AMI. PSA/albumin ratio was also calculated in order to evaluate the effect of dilution. A statistical analysis of the results of all patients revealed significant decrease in tPSA levels and tPSA/Albumin ratio at day 2 when compared to days 0 and 3, which showed a similar pattern. Changes of fPSA and fPSA/ Albumin ratio according to days were not found significant. In only four patients we found increased levels of tPSA and increased fPSA levels in three of them. These patients displayed severe problems such as renal failure, cardiac failure, ventricular aneurysm and cerebral ischemia due to cardiac arrest. The lower tPSA levels on day 2 suggest that tPSA can be eliminated rapidly from the circulation on days 1 and 2, probably through the formation of complexes of tPSA with acute phase proteins.

High grade intraepithelial neoplasia of prostate is associated with values of prostate specific antigen related parameters intermediate between prostate cancer and normal levels

High grade prostatic intraepithelial neoplasia (HGPIN) is widely regarded as the precancerous. The aim of this study was to determine PSA related parameters in patients with initial PSA values 2-10 ng/mL and diagnosis of HGPIN without finding carcinoma at the time of their first needle biopsy. Study groups consisted of 100 men who were diagnosed HGPIN, 84 with cancer and 183 with benign hyperplasia on first biopsy of prostate. Total PSA and free PSA were measured and ratio free/total PSA and PSA density calculated. Mean values of these parameters were compared, and receiver operating characteristic curves were used for comparison of PSA related parameters to discriminate groups of patients.Total PSA, free PSA level and PSA density in patients with HGPIN (6.388 ng/mL) did not differ significantly compared to prostate carcinoma (6.976 ng/mL) or benign prostatic hyperplasia (6.07 ng/mL) patients. Patients with HGPIN had significantly higher ratio free/total PSA than those with prostate carcinoma (0.168 vs 0.133), but significantly lower than patients with benign prostatic hyperplasia (0.168 vs 0.185). Ratio of free/total PSA significantly discriminate HGPIN from prostate carcinoma with sensitivity 84.52 and specify 45.00 at cut-off point of ≤ 0.18. Values of PSA, free PSA and ratio free/total PSA in cases of HGPIN appear to be intermediate between prostate cancer and normal levels. Ratio of free/total PSA may help in decision to repeat biopsies in the presence of HGPIN on biopsy, without concomitant prostate cancer, in patients suitable for curative treatment, with normal digito-rectal examination and trans-rectal sonography.

Changes in Prostate Specific Antigen in Hypogonadal Men After 12 Months of Testosterone Replacement Therapy: Support for the Prostate Saturation Theory

We measured prostate specific antigen after 12 months of testosterone replacement therapy in hypogonadal men. Data were collected from the TRiUS (Testim® Registry in the United States), an observational registry of hypogonadal men on testosterone replacement therapy (849). Participants were Testim naïve, had no prostate cancer and received 5 to 10 gm Testim 1% (testosterone gel) daily. A total of 451 patients with prostate specific antigen and total testosterone values were divided into group A (197 with total testosterone less than 250 ng/dl) and group B (254 with total testosterone 250 ng/dl or greater). The groups differed significantly in free testosterone and sex hormone-binding globulin, but not in age or prostate specific antigen. In group A but not group B prostate specific antigen correlated significantly with total testosterone (r=0.20, p=0.005), free testosterone (r=0.22, p=0.03) and sex hormone-binding globulin (r=0.59, p=0.002) at baseline. After 12 months of testosterone replacement therapy, increase in total testosterone (mean±SD) was statistically significant in group A (+326±295 ng/dl, p<0.001; final total testosterone 516±28 ng/dl) and group B (+154±217 ng/dl, p<0.001; final total testosterone 513±20 ng/dl). After 12 months of testosterone replacement therapy, increase in prostate specific antigen was statistically significant in group A (+0.19±0.61 ng/ml, p=0.02; final prostate specific antigen 1.26±0.96 ng/ml) but not in group B (+0.28±1.18 ng/ml, p=0.06; final prostate specific antigen 1.55±1.72 ng/ml). The average percent prostate specific antigen increase from baseline was higher in group A (21.9%) than in group B (14.1%). Overall the greatest prostate specific antigen was observed after 1 month of treatment and decreased thereafter. Patients with baseline total testosterone less than 250 ng/dl were more likely to have an increased prostate specific antigen after testosterone replacement therapy than those with baseline total testosterone 250 ng/dl or greater, supporting the prostate saturation hypothesis. Clinicians should be aware that severely hypogonadal patients may experience increased prostate specific antigen after testosterone replacement therapy.

Intact and Internally Cleaved Free Prostate-Specific Antigen in Patients With Prostate Cancer With Different Pathologic Stages and Grades

To measure the concentration levels of free prostate-specific antigen (PSA) isoforms in patients with prostate cancer selected for curative treatment using radical prostatectomy and to study the association between the isoforms and the pathologic cancer stage and grade. Preoperative plasma samples were obtained from 309 consecutive patients scheduled to undergo radical prostatectomy at Turku University Hospital. The pathologic TNM stage, Gleason score, and World Health Organization grade of the tumors were recorded. The total, free, and intact PSA (tPSA, fPSA, and fPSA-I, respectively) concentrations of the archived samples were measured with in-house immunoassays, and the nicked PSA (fPSA-N) concentrations (fPSA minus fPSA-I) and ratios of different PSA forms were calculated. These were compared with the prostate cancer stage, Gleason score, and World Health Organization grade. The median fPSA-I and fPSA-N concentrations in the patients with prostate cancer was 0.42 and 0.28 ng/mL, constituting an average of 60% and 40% of fPSA, respectively. The nicked/total PSA and free/total PSA ratios had the strongest negative correlations with a higher pathologic stage, Gleason score, and World Health Organization grade (Spearman rho -0.205 to -0.262, P < .05). Within a patient subgroup with tPSA <10 ng/mL, fPSA-N as a single marker had a negative correlation with a higher Gleason score (rho -0.160, P = .021). Lower proportions of fPSA-I and fPSA-N to total PSA were associated with a more advanced cancer stage and grade. A long-term follow-up study and a comparison with currently used clinical methods are needed to evaluate the usefulness of the analytes as prognostic markers for cancer aggressiveness in individual patients.

Antibiotics and observation have a similar impact on asymptomatic patients with a raised PSA

• To compare the influence of a 4-week course of empirical antimicrobial therapy or observation on the prostate-specific antigen (PSA) levels of asymptomatic patients with a raised baseline PSA. • To identify whether a decrease in PSA can predict the risk of prostate cancer (PCa) detection on prostate biopsy. • Patients were referred to our ambulatory centre because of a raised PSA level (>2.5 ng/mL) with a normal digital rectal examination. A 12-core prostate biopsy was indicated in these patients and they were offered antibiotic treatment with levofloxacin 500 mg daily for 30 days. • Patients who did not agree to use antibiotics but who still showed interest in participating underwent simple observation, serving as controls. • Total and free PSA levels at baseline and after 45 days were measured. Variation in PSA level was calculated. • All patients underwent a 12-core prostate biopsy 6 weeks after the initial visit. • In all, 245 men were enrolled, but 43 were lost due to follow-up. A total of 145 patients who used antibiotics and 57 controls were included in the analysis. • The median baseline PSA levels were 7.6 and 7.7 ng/mL in the antibiotic and control groups, respectively, with median follow-up levels of 6.8 and 7.0 ng/mL. The follow-up PSA level was significantly lower than the initial PSA level (P = 0.009). • Mean absolute and percentage variation in PSA level were similar in both groups (P = 0.828 and 0.128, respectively). • The overall PCa detection rate was 15.8%, and did not differ among the groups (P = 0.203). Regarding the percentage variation in PSA level, patients diagnosed with PCa tended to have their PSA level increased (22.4 vs -5.3%; P = 0.001). Indeed, a decrease of 20% in PSA was not predictive of a negative prostate biopsy (P = 0.41). • The area under the receiver operating characteristic curve for percentage PSA variation as a predictor of PCa was 0.660. • PSA levels tend to fall when repeated after 45 days, regardless of antibiotic use. • Despite being associated with the chance of PCa, no percentage PSA variation threshold value exhibits satisfactory discriminatory properties.

The Effect of CO2 Pneumoperitoneum on Serum Prostate-Specific Antigen Levels in Patients Undergoing Laparoscopic Cholecystectomy

Recently, several studies have shown an elevation of serum prostate-specific antigen (PSA) levels after the events associated with presumed pelvic ischemia. Although it has been shown that CO2 pneumoperitoneum during laparoscopic surgery causes splanchnic ischemia, no study has investigated the PSA levels after this procedure. This study aimed to evaluate the effects of CO2 pneumoperitoneum on serum total PSA (tPSA) and free PSA (fPSA) levels in patients undergoing laparoscopic cholecystectomy. This study involved 30 men who underwent elective laparoscopic cholecystectomy. Serum tPSA and fPSA levels and f/tPSA ratios were determined the day before surgery (baseline), immediately before insufflation, after desufflation, and 24 hours and 7 days after surgery. Serum tPSA and fPSA values after desufflation and 24 hours after surgery were significantly higher than the values before insufflation and at baseline (P<0.01), whereas the f/tPSA ratio did not change (P>0.05). PSA levels decreased to baseline levels after 7 days. Our study showed that CO2 pneumoperitoneum during laparoscopic surgery can cause a rise in serum tPSA and fPSA levels. We think that CO2 pneumoperitoneum during laparoscopic surgery should be added to list of the events in which PSA measurements must be interpreted with caution.

Elevation of the serum total and free prostate specific antigen levels after stent implantation in patients with coronary artery disease.

Prostate specific antigen (PSA) is the most important biochemical marker in the diagnosis and follow-up of patients with prostate cancer. In recent years, a relationship between PSA levels and cardiovascular conditions has been described. However, no study has investigated the PSA levels after coronary stenting. To investigate the impact of coronary stent implantation on serum total PSA (tPSA) and free PSA (fPSA) levels. This study involved 60 men who underwent coronary angiography for suspected coronary artery disease. Of these, 25 were diagnosed as having angiographically normal coronary arteries (Group 1) and 35 underwent coronary stent implantation (Group 2). Serum tPSA and fPSA levels and f/tPSA ratios were determined in all patients immediately before the intervention and 24 hours and 30 days after the procedure. In Group 1, there was no statistically significant change in the values of tPSA, fPSA and f/tPSA ratio before and after coronary angiography (p >0.05). In Group 2, tPSA and fPSA values 24 hours after stent implantation were significantly higher than the values at the baseline (p <0.01), whereas f/tPSA ratio did not change (p >0.05). Compared with the baseline, there was no statistically significantly difference in the PSA values 30 days after stent implantation (p >0.05). This study demonstrated that serum tPSA and fPSA levels are increased after coronary stent implantation, but f/tPSA ratio is not affected. The findings suggest that serum tPSA and fPSA levels should not be used for the diagnosis of prostate cancer during the first 30 days after coronary stenting.

Elevation of the serum total and free prostate specific antigen levels after stent implantation in patients with coronary artery disease.

Prostate specific antigen (PSA) is the most important biochemical marker in the diagnosis and follow-up of patients with prostate cancer. In recent years, a relationship between PSA levels and cardiovascular conditions has been described. However, no study has investigated the PSA levels after coronary stenting. To investigate the impact of coronary stent implantation on serum total PSA (tPSA) and free PSA (fPSA) levels. This study involved 60 men who underwent coronary angiography for suspected coronary artery disease. Of these, 25 were diagnosed as having angiographically normal coronary arteries (Group 1) and 35 underwent coronary stent implantation (Group 2). Serum tPSA and fPSA levels and f/tPSA ratios were determined in all patients immediately before the intervention and 24 hours and 30 days after the procedure. In Group 1, there was no statistically significant change in the values of tPSA, fPSA and f/tPSA ratio before and after coronary angiography (p >0.05). In Group 2, tPSA and fPSA values 24 hours after stent implantation were significantly higher than the values at the baseline (p <0.01), whereas f/tPSA ratio did not change (p >0.05). Compared with the baseline, there was no statistically significantly difference in the PSA values 30 days after stent implantation (p >0.05). This study demonstrated that serum tPSA and fPSA levels are increased after coronary stent implantation, but f/tPSA ratio is not affected. The findings suggest that serum tPSA and fPSA levels should not be used for the diagnosis of prostate cancer during the first 30 days after coronary stenting.

Elevation of the serum total and free prostate specific antigen levels after stent implantation in patients with coronary artery disease.

Prostate specific antigen (PSA) is the most important biochemical marker in the diagnosis and follow-up of patients with prostate cancer. In recent years, a relationship between PSA levels and cardiovascular conditions has been described. However, no study has investigated the PSA levels after coronary stenting. To investigate the impact of coronary stent implantation on serum total PSA (tPSA) and free PSA (fPSA) levels. This study involved 60 men who underwent coronary angiography for suspected coronary artery disease. Of these, 25 were diagnosed as having angiographically normal coronary arteries (Group 1) and 35 underwent coronary stent implantation (Group 2). Serum tPSA and fPSA levels and f/tPSA ratios were determined in all patients immediately before the intervention and 24 hours and 30 days after the procedure. In Group 1, there was no statistically significant change in the values of tPSA, fPSA and f/tPSA ratio before and after coronary angiography (p >0.05). In Group 2, tPSA and fPSA values 24 hours after stent implantation were significantly higher than the values at the baseline (p <0.01), whereas f/tPSA ratio did not change (p >0.05). Compared with the baseline, there was no statistically significantly difference in the PSA values 30 days after stent implantation (p >0.05). This study demonstrated that serum tPSA and fPSA levels are increased after coronary stent implantation, but f/tPSA ratio is not affected. The findings suggest that serum tPSA and fPSA levels should not be used for the diagnosis of prostate cancer during the first 30 days after coronary stenting.

Does the Type of Prostatic Atrophy Influence the Association of Extent of Atrophy in Needle Biopsies and Serum Prostate-specific Antigen Levels?

To consider the possibility that a positive and significant association between extent of atrophy and serum total or free prostate-specific antigen (PSA) elevation in patients with biopsies showing no cancer, high-grade prostatic intra-epithelial neoplasia or areas suspicious for cancer found in a previous study may be related to the type of atrophy. The only diagnosis in 75 extended biopsies was focal prostatic atrophy. Both partial and complete atrophy were considered. Complete atrophy was subtyped into simple, hyperplastic, and sclerotic atrophy. The extent of each type of atrophy was measured in 2 ways: the linear extent in millimeters and the percentage of linear extent showing atrophy for each biopsy. On the basis of the median value of serum total PSA, the patients were divided into 2 groups: group A patients with PSA <or= 8.2 ng/mL, and group B patients with PSA > 8.2 ng/mL. There was a positive and statistically significant correlation of the linear atrophy extent as well as the percentage of linear extent with total and free serum PSA level. There was no statistically significant difference in the distribution of extent according to the type of atrophy between groups A and B. There is a positive and significant association between extent of atrophy and serum PSA elevation. This association is not related to the type of atrophy. We hypothesize that stress-induced response by inflammation and/or ischemia may interfere in the physiological barrier that prevents any significant amount of PSA to gain the general circulation.

Aggressiveness of Inflammation in Histological Prostatitis – Correlation with Total and Free Prostate Specific Antigen Levels in Men with Biochemical Criteria for Prostate Biopsy

Although prostatitis can contribute to the lack of prostate specific antigen (tPSA) specificity, there is disagreement concerning the effect of histological inflammation on free PSA (fPSA). We investigated the correlation between aggressiveness of histological inflammation and tPSA, fPSA and f/tPSA in patients without detectable prostate cancer (PC). The study included 106 patients with tPSA <10 ng/mL, without clinical prostatitis and with biopsy negative for PC. The inflammation in prostate biopsies was scored for aggressiveness using the four-point scale reported by Irani. The patients were divided into two groups of less aggressive and more aggressive inflammation and compared by use of regression analysis. The median tPSA, fPSA and f/tPSA levels were 6.39 ng/mL, 1.1 ng/mL and 16% in the less aggressive inflammation group and 7.3 ng/mL, 0.79 ng/mL and 10.7% in the more aggressive inflammation group, respectively. There was no significant between-group difference in tPSA levels (P=0.16), however, statistically significant between-group differences were recorded in fPSA and f/tPSA levels (P<0.001 both). Spearman's analysis yielded a significant negative correlation of inflammation aggressiveness with fPSA (r=-0.34; P<0.001) and f/tPSA (r=-0.45; P<0.001). Free PSA and f/tPSA were lower in the group with more aggressive inflammation. Histological inflammation has a high prevalence in cancer-free prostate biopsy specimens and exerts similar effects on fPSA and f/tPSA levels as PC. Our study suggests histological prostatitis to be an important cause of decreased fPSA and f/tPSA values; therefore, when it is identified, antibiotic or anti-inflammatory therapy should be introduced to reduce the percentage of men with a continuing indication for prostate biopsy.

Prostate specific antigen in women with menstrual disturbances and fibrocystic mastopathy

The objective of this study was to evaluate serum prostate specific antigen (PSA) levels in women with menstrual disturbances and fibrocystic mastopathy. A total of 114 women with fibrocystic breast disease with cysts <10 mm (group I), 62 with macrocysts >10 mm (group II) and 46 healthy volunteers, who served as control subjects, were recruited for this prospective study. Each patient underwent complete gynecological examination and had performed sonography of the breasts. Moreover menstrual pattern, serum levels of free and total PSA, LH, FSH, SHBG, PRL, estradiol, progesterone, TSH, T4, as well as serum total testosterone, were evaluated in each subject. We compared serum free and total PSA levels between women with different menstrual pattern within groups of women with micro- and macrocysts. We also evaluated correlations between serum free and total PSA and hormonal/descriptive variables. We found that, in group II, women with regular menses and polymenorrhea revealed significantly higher serum free PSA than women with oligomenorrhea and secondary amenorrhea. Moreover, we found a positive correlation between serum total testosterone and total PSA in the control group and between progesterone and total PSA in group II. Our data show that serum free PSA is increased in women with regular menstrual cycles and polymenorrhea. This later relationship refers to women with macrocysts. Further studies are required to clarify the relationships between serum PSA and menstrual disturbances in women with mastopathy.

Frequency and outcome of metaplasia in needle biopsies of prostate and its relation with clinical findings.

Metaplasia is a reversible change in which one adult cell type is replaced by another adult cell type. Our aim was to determine the frequency and outcome of metaplasia in specimens from needle biopsies of the prostate and its relation with clinical findings. Among 1566 prostate specimens referred to 2 pathology centers of Tehran, we studied on cases with a diagnosis of metaplasia, during a 2-year period. The clinical and laboratory data of the patients with metaplasia were collected, and they were followed-up for 2 years. Age, serum total and free prostate-specific antigen levels, ultrasonography findings, and results of digital rectal examination were recorded at baseline and the follow-up period. Ten prostate specimens (0.6%) had metaplasia, of which 6 were transitional and 4 were squamous metaplasia. Serum total PSA levels ranged from 0.7 ng/mL to 14.5 ng/mL, and free PSA levels ranged from 0.1 ng/mL to 1.3 ng/mL in the patients with metaplasia. None of the patients developed carcinoma of the prostate during the 2-year follow-up, and no significant changes were seen in the follow-up studies. Metaplasia of the prostate are often associated with BPH. Clinical findings on DRE and TRUS resemble those found in benign lesions of the prostate, such as BPH. We found no sign of developing malignancy in our 2-year follow-up. However, in the differential diagnosis of this benign lesion, malignant lesions, such as squamous cell carcinoma or urothelial transitional cell carcinoma, should also be taken into consideration.

Effects of G/A polymorphism, rs266882, in the androgen response element 1 of the PSA gene on prostate cancer risk, survival and circulating PSA levels

Prostate-specific antigen (PSA) is a protease produced in the prostate that cleaves insulin-like growth factor binding protein-3 and other proteins. Production is mediated by the androgen receptor (AR) binding to the androgen response elements (ARE) in the promoter region of the PSA gene. Studies of a single nucleotide polymorphism (PSA −158 G/A, rs266882) in ARE1 of the PSA gene have been conflicting for risk of prostate cancer and effect on plasma PSA levels. In this nested case–control analysis of 500 white cases and 676 age- and smoking-matched white controls in the Physicians' Health Study we evaluated the association of rs266882 with risk and survival of prostate cancer and prediagnostic total and free PSA plasma levels, alone or in combination with AR CAG repeats. We used conditional logistic regression, linear regression and Cox regression, and found no significant associations between rs266882 (GG allele vs AA allele) and overall prostate cancer risk (RR=1.21, 95% confidence intervals (CI): 0.88–1.67) or prostate cancer-specific survival (RR=0.94, 95%CI: 0.56–1.58). Similarly, no associations were found among high grade or advanced stage tumours, or by calendar year of diagnosis. There was no significant association between rs266882 and baseline total or free PSA levels or the AR CAG repeats, nor any interaction associated with prostate cancer risk. Meta-analysis of 12 studies of rs266882 and overall prostate cancer risk was null.

The effect of testosterone therapy on lower urinary tract symptoms/bladder and sexual functions in men with symptomatic late-onset hypogonadism

Objective. To prospectively investigate the effect of testosterone therapy on lower urinary tract symptoms (LUTS)/bladder and sexual functions in men with symptomatic late-onset hypogonadism (SLOH).Methods. The study included 25 men (age range 38 to 73 years) presented with sexual dysfunction, having SLOH, at a single university hospital. All men received testosterone replacement therapy with transdermal testosterone 50–100 mg gel per day for one year. Urodynamic studies with pressure-flow analysis, measurement of prostate volume, prostate specific antigen (PSA) and free PSA level, International Prostate Symptom Score (IPSS), Aging Male Symptom (AMS) scale and International Index of Erectile Function (IIEF-5) score were recorded in all men before and after one year of the treatment.Results. The mean AMS score significantly decreased from 40.4 ± 7.3 to 28.8 ± 5.31 (p = 0.001), and mean IIEF-5 score significantly increased from 8.84 ± 3.76 to 14.36 ± 3.62 (p = 0.001). The mean maximal bladder capacity and compliance significantly increased (p = 0.007 and p = 0.032, respectively), and mean detrusor pressure at Qmax significantly decreased from pre-treatment to post-treatment (p = 0.017).Conclusion. This study suggests that in addition to improvement in sexual functions, testosterone therapy may also improve LUTS/bladder functions by increasing bladder capacity and compliance and decreasing detrusor pressure at maximal flow in men with SLOH.

Prostate-specific antigen in the serum of women with benign breast disease

Objectives Fibrocystic mastopathy is the most common benign breast disease. Available evidence suggests that the presence of breast cysts increases the risk of breast cancer. The purpose of the study was to evaluate and compare the detection rate of total and free prostate-specific antigen (PSA) in the serum samples of healthy women and in those of women with cystic mastopathy. Moreover, we compared PSA concentrations in the serum samples of the study groups. Study design The study population included 114 women with fibrocystic breast disease, with cysts measuring <10 mm (Group I) and 62 with macrocysts measuring >10 mm (Group II). Forty-six healthy volunteers were enrolled in the study as a control group. We analyzed the frequency of the detection level and the mean serum concentrations of total and free PSA in women with mastopathy and in healthy participants. Total PSA (PSA-T) and free PSA (PSA-Free) were measured by an ultrasensitive fluoroimmunometric DELFIA assay (Prostatus PSA Free/Total Wallac, Turku, Finland). The detection limits was 0.01 ng/ml. Results Our results showed the statistical significance of the fact that the detection rate of free and total PSA was higher in all women with mastopathy (Group I with II) than it was in the control group. There were no differences between Group I and Group II regarding the detection rate of the two forms of antigen and between the control group and Group II in the detection rate of total PSA. We also demonstrated that the mean concentration levels of both free and total PSA were significantly higher in the serum of women with mastopathy than in the control group. Conclusion These findings suggest that women with mastopathy, regardless of the size of the cysts, produce and release more PSA into the serum than women without breast pathology. The PSA may be a new marker for the assessment of benign breast disease.

Assay Standardization Bias: Different Prostate Cancer Detection Rates and Clinical Outcomes Resulting from Different Assays for Free and Total Prostate-Specific Antigen

Numerous commercial assays are available for measuring total and free prostate-specific antigen (PSA) levels in serum. These assays can be referenced to different laboratory standards, and interassay variability occurs. Patients and physicians might be affected by the variability between PSA assays that results from the use of different PSA standards. We prospectively compared the free and total PSA measurements obtained using two commercially available PSA assays in 103 participants from a prostate cancer screening program in Caracas, Venezuela. We recommended biopsy to men with a total PSA level of 3 to 10 ng/mL and a free/total PSA ratio of 20% or less with either assay. We compared the sensitivity, specificity, and concordance index between the two assays to assess the effects of interassay variability on the cancer detection rate and clinical outcomes. Although the total PSA results were similar between the assays, the free PSA level was significantly greater with one assay. Therefore, the free/total PSA ratio was discordant between the two assays, resulting in different biopsy recommendations and cancer detection rates. Using a free/total PSA ratio of 20% or less as the threshold for biopsy, the differences in assay sensitivity and specificity for detecting prostate cancer are significant. Commercially available assays for PSA and its derivatives are not necessarily interchangeable, and these differences might lead to different clinical outcomes. When using free and total PSA measurements to make clinical decisions, patients and physicians should be aware of the potential standardization bias and which assay is being used.

Extent of Prostatic Atrophy in Needle Biopsies and Serum PSA Levels: Is There an Association?

Prostatic atrophy is one of the most frequent benign mimics of prostate adenocarcinoma. Regardless of the cause, we hypothesized that damaged epithelial cells in the atrophic acini could be a source of the elevation of serum prostate-specific antigen (PSA). The aim of this study was to find any possible association between the extent of prostatic atrophy in needle biopsies and serum PSA level. The study was based on 131 needle prostatic biopsies corresponding to 107 patients. The only diagnosis in all biopsies was focal prostatic atrophy without the presence of cancer, high-grade prostatic intraepithelial neoplasia, or areas suspicious for cancer. The extent of atrophy was measured in two ways: the linear extent in millimeters and the percentage of linear extent showing atrophy for each biopsy. Spearman's coefficient of rank correlation was used to evaluate the association of atrophy extent with total and free serum PSA levels. A positive and statistically significant correlation was found between the linear atrophy extent and the total serum PSA level (r = 0.25, P = <0.01) and free PSA level (r = 0.23, P = 0.01). A positive and statistically significant correlation was found between the percentage of the linear extent showing atrophy and the total serum PSA level (r = 0.23, P = 0.01) and free PSA level (r = 0.20, P = 0.02). A positive and significant association was found between the extent of atrophy and the total or free serum PSA elevation. The findings suggest that damaged epithelial cells in atrophic acini, regardless of cause, could be a source of serum PSA elevation.