Higher Serum Prostate-specific Antigen Levels Research Articles

Lifestyle and risk factors associated with elevated prostate-specific antigen levels in rural men: implications for health counseling.

The use of prostate-specific antigen (PSA) for early detection of prostate cancer (PCa) is common but controversial. In rural areas, PSA is widely used for screening because it is convenient and early-stage PCa often shows no symptoms. Studies suggest that PSA levels are linked to factors like unhealthy lifestyles, obesity, lack of exercise, inflammation, and aging. Proper use and interpretation of PSA are crucial for healthcare providers, especially in primary care settings. This study aims to explore the prevalence and factors linked to higher PSA levels in rural men. We conducted a community-based cross-sectional study from March to December 2023 in the western coastal region of Taiwan. Men aged 40-75 years participated, completing a lifestyle questionnaire and providing blood samples for cardiometabolic biomarkers and PSA levels. PSA levels of ≥ 4.0 ng/mL were considered elevated. We used propensity score matching (PSM) and genetic matching (GM) for analysis, followed by regression analysis. In total, 3347 male adults with a mean age of 56.3 years (SD=11.8, range 40-75), and without cancer-related diseases, were enrolled. Findings indicated that 3.9% (n=130) of men aged 40-75 years had a PSA ≥ 4 ng/mL. and many of them did not adopt health-related behaviors, including inadequate servings of vegetables, water intake, and engaging in regular exercise. Furthermore, more than half of the participants had high blood pressure, and over one-quarter exhibited a higher waist-hip ratio and cardiometabolic diseases. After employing propensity score matching (PSM) and genetic matching (GM) with respect to age and education, the multivariate logistic regression model indicated that less water intake (p<0.01), higher waist-hip ratio (> 0.95) (p<0.05), and being diagnosed with cardiometabolic diseases (p<0.05) were significantly associated with a higher serum PSA level. This study revealed that inadequate water intake and obesity related diseases are significant risk factors associated with elevated PSA levels among male adults living in rural areas. It is important for frontline healthcare providers to carefully interpret the meaning of a high PSA level. Additionally, launching a longitudinal study is necessary to further investigate its relation to PCa.

Exposure to environmental pollutants and genetic variants related to oxidative stress and xenobiotic metabolism—Association with prostate cancer

This study assessed whether genetic variants coding for certain enzymes involved in xenobiotic detoxification, antioxidant defences and DNA repair, along with exposure to environmental chemicals, were associated with an increased prostate cancer (PCa) risk. The study population consisted of 300 men (150 PCa cases and 150 controls) which underwent prostate biopsy as their serum prostate specific antigen (PSA) levels were greater than 4 ng/ml. Genetic variants in GSTM1, GSTP1, SOD2, CAT, GPX1, XRCC1 were determined and data for chemical exposures was obtained through a structured questionnaire and by biomonitoring in a subsample of cases and controls. High serum PSA levels were associated with a greater risk of PCa, while physical exercise appears to exert a protective effect against its development. In addition, elevated urinary levels of certain organic pollutants, such as benzo(a)pyrene (BaP), bisphenol A (BPA), and ethyl-paraben (EPB), were associated with an increased risk of PCa.

Prevalence of Helicobacter pylori, Mycobacterium tuberculosis, Malaria Infections, and High Serum Prostate Specific Antigen Levels among Individuals at the Rivers State University, Nigeria: Findings of a Free Medical Outreach

Background: Co-morbidity of infections and non-infectious diseases is increasing in developing societies with little effort in identifying these trends. The study aimed to estimate the prevalence of Helicobacter pylori, Mycobacterium tuberculosis, malaria infections, and high serum prostate-specific antigen levels among individuals and residents at Rivers State University, Port Harcourt, Nigeria.&#x0D; Experimental Design: The study is a cross-sectional descriptive study, which consisted of 501 participants in a free medical outreach organized by the Association of Medical Laboratory Scientists of Nigeria, Rivers State University Chapter, Rivers State, Nigeria, in commemoration of the 2022 International Biomedical Day. The test subjects consisted of males and females, who were students, staff, and residents at the Rivers State University, Port Harcourt, Nigeria. The age range of the test subjects was 18-64 years.&#x0D; Methods: The cross-sectional descriptive study encompassed 501 adults (males and females) who gave consent for their blood screening during our free medical outreach. As a procedure, venous blood specimens were collected at the antecubital fossa from the attendees by venipuncture technique and were screened forH. Pylori antibody, Mycobacterium tuberculosis, malaria parasite, and prostate-specific antigen with the use of Accu-Tell rapid diagnostic test kits. Each test was read within 10 minutes. Red lines on the test zone and control zones of the test kits were read and recorded as positive cases, while a red line on the control zone and the absence of a red line on the test zone of the test kit were read, and recorded as negative case, in line with the rapid diagnostic manufacturer’s instructions.&#x0D; Results: Out of a total of 501 participants, the prevalence of H. pylori, M. tuberculosis, Plasmodium falciparum, and prostate-specific antigen were 9 (1.79 %), 3 (0.6 %), 12 (2.40 %), 6 (4.65 %%) respectively. The sex-based comparison showed that males have the same prevalence for all infectious diseases (H. pylori, M. tuberculosis, and P. falciparum) of 3 (2.32 %), and 6 (4.65 %) for a prostate-specific antigen. For the females, the prevalence of H. pylori, M. tuberculosis and P. falciparum were 6 (2.20 %), 0 (0.00 %), and 9 (2.42 %) respectively.&#x0D; Conclusion: M. tuberculosis prevalence was observed to be greater in the males than in the females of the studied population while that of H. pylori was observed to be higher in the females than the male participants. So continuous screening of the public to monitor and prepare them against the insurgence of these diseases which are of public health concern is important.

Elevated prostate-specific antigen in Paget’s disease

ABSTRACT A 70-year-old man diagnosed with acinar adenocarcinoma prostate (Gleason score 4 + 4 = 8) underwent bone scintigraphy due to high serum prostate-specific antigen level (224 ng/mL; normal &lt;4 ng/mL). Bone scan revealed moderately increased diffuse tracer uptake in the right hemipelvis, while the rest of the scan appeared normal, leading to suspicion of Paget’s disease. Gallium-68-prostate-specific membrane antigen (PSMA) positron emission tomography–computed tomography scan (CT) showed a PSMA-avid lesion in the left lobe of the prostate, with no PSMA uptake in the areas of diffuse sclerosis in the right hemipelvis, as seen on CT. This confirmed the diagnosis of Paget’s disease.

Comparison of Serum Gamma Glutamyl Transferase Levels between Prostate Cancer Patients and Their Healthy Peers.

Prostate cancer (PCa) is the most common cancer affecting men, apart from cutaneous cancers. Serum prostate specific antigen (PSA) levels are frequently used to predict prostate cancer diagnosis. However, many causes (e.g., prostatitis, benign prostate obstruction, urethral catheterization) may cause elevated PSA, in addition to PCa. We aimed to investigate the gamma glutamyl transferase (GGT) levels, a serum biomarker not affected by situations other than cancer causing elevated PSA. The study evaluated male patients with prostate biopsy due to high serum PSA levels and/or abnormal digital rectal examination (DRE) examined in Ordu University Education and Research Hospital, Ordu/Turkey urology clinic from April 2019 to April 2021. The patient group in the study included 261 men with PCa diagnosis and the control group included 245 healthy men with normal PSA levels, and no PCa and/or benign prostate obstruction (BPO). The two groups were compared in terms of serum GGT levels. GGT was significantly low in the PCa group and might be a predictor in terms of PCa (P=0.000). In the malignant (PCa) group, the GGT cut-off value was identified as 21.5 (sensitivity 68.6%, specificity 54.4%). Serum GGT levels might assist in diagnosis of PCa. However, diagnostic power is weak due to low specificity. There is a need for studies investigating the efficacy of GGT levels for prediction of PCa diagnosis and assessing other parameters alongside GGT.

Risks of prostate cancer and mortality in the city of Sharjah, United Arab Emirates.

Prostatic hyperplasia (BPH) and prostate cancer (PCa) are common age-related diseases in men. According to World Health Organization (WHO), PCa is the second most common cancer among Emirati men. This study aimed to identify the risk factors associated with PCa and mortality in a cohort diagnosed with PCa between 2012 and 2021 in Sharjah, United Arab Emirates (UAE). The data collected in this retrospective case-control study included patient demographics and comorbidities, as well as PCa markers such as prostate-specific antigen (PSA), prostate volume, prostate-specific antigen density (PSAD), and Gleason scores. Risk factors for PCa were assessed using multivariate logistic regression analysis, and factors associated with all-cause mortality in PCa patients were evaluated using Cox-proportional hazard analysis. Of the 192 cases analyzed in this study, 88 were diagnosed with PCa and 104 were diagnosed with BPH. Regarding risk factors for PCa, a higher risk of PCa was associated with age 65 or older (OR=2.76, 95% confidence interval (CI): 1.04-7.30; P=0.038) and serum PSAD greater than 0.1 ng/mL2 (OR=3.48, 95% CI:1.66-7.32; P=0.001), whereas being of UAE nationals (OR=0.40, 95% CI:0.18-0.88; P=0.029) were associated with lower risk of PCa, after adjusting for patient demographics and comorbidities. Moreover, regarding cancer markers, higher serum PSA level (P=0.003) and smaller prostate volume (P=0.028) were associated with a higher risk of PCa, after adjusting with patients' age and BMI. Additionally, a high-grade Gleason score was associated with an increased risk of all-cause mortality after adjusting for patient's age and BMI (hazard ratio, aHR= 2.3, 95% CI:1.3-4.1; P= 0.016). This study found that age 65 or older and serum PSAD greater than 0.1 ng/mL2 are risk factors for PCa, while UAE nationality is associated with a lower risk. PSAD may be a better screening marker for PCa compared to traditional markers such as PSA and prostate volume.

Lymphocyte-to-monocyte ratio is a predictor of clinically significant prostate cancer at prostate biopsy.

Inflammation plays critical roles at different stages of carcinogenesis and cancer progression. Several previous studies showed conflicting results for the predictive role of systemic inflammation markers in the detection of clinically significant prostate cancers (CSPCs). We aimed to determine the predictive roles of lymphocyte-to-monocyte (LMR) and eosinophil-to-lymphocyte ratios (ELR) in the detection of CSPC at standard 12-core transrectal ultrasound-guided prostate biopsy (12-core-TRUS-Bx) using our large-cohort database. Clinical and pathological data of a total of 1740 men, who underwent initial standard 12-core TRUS-Bx, were analyzed. LMR and ELR were calculated from the prebiopsy complete blood count. Definitions of CSPC, LMR, and ELR were "Gleason grade group ≥2," "the lymphocyte counts/the monocyte counts," and "the eosinophil counts/the lymphocyte counts," respectively. Median (interquartile range) of serum prostate-specific antigen(PSA) level and prostatic volume before TRUS-Bx were 7.59 (5.02-13.12) ng/ml and 38.2 (29.0-52.9) ml, respectively. Benign prostatic lesions, clinically insignificant prostate cancers (CIPCs), and CSPCs were detected in 1179 (67.8%), 180 (10.3%), and 381 (21.9%) patients, respectively. The patients with CSPCs had older age, a higher prevalence of diabetes mellitus or hypertension, a higher rate of digital rectal examination abnormality, higher serum PSA level, lower serum testosterone level, and lower LMR than those with benign lesions or CIPCs. However, there was no difference in ELR among the three (benign lesions, CIPCs and CSPCs). In all the patients, multivariate regression analysis showed that lower LMR was an independent predictor of CSPCs compared with ELR. In the subset of men with prostate volume ≥39.3 ml, lower LMR was an independent predictor of CSPCs compared with ELR. In the subset of men with prostate volume <39.3 ml, men with lower LMR showed the tendency of having a higher probability of CSPCs without any statistical significance on the contrary to ELR. Our data indicate that LMR can play an independent predictive role in the detection of CSPCs at initial 12-core-TRUS-Bx compared with ELR. The predictive role of the LMR appears to be significant for men with larger prostate volume rather than those with smaller prostate volume.

Platelet-to-lymphocyte ratio is not a predictor of clinically significant prostate cancer at the prostate biopsy: A large cohort study

Previous studies have reported conflicting results on the predictive role of the platelet-to-lymphocyte ratio (PLR) in detecting clinically significant prostate cancer (CSPCa) at the time of prostate biopsies. We explored the predictive value of pre-biopsy PLRs for CSPCa using our large-cohort database. Consecutive men with serum prostate-specific antigen (PSA) levels of ≥ 3.0 ng/mL or abnormal digital rectal examination (DRE) findings and who underwent prostate biopsies were included in the study. There was no significant difference in the pre-biopsy PLR between men with benign disease, clinically insignificant prostate cancer (CISPCa), and CSPCa. Only the subset of CSPCa patients with serum PSA levels of < 10 ng/mL showed lower PLRs than those with benign disease or CISPCa. In the entire patient cohort, multivariate analyses revealed that older age, diabetes mellitus, DRE abnormalities, higher serum PSA levels, and smaller prostate volume were predictors of CSPCa. However, the pre-biopsy PLR was not a significant predictor of CSPCa at the prostate biopsy in the entire patient cohort or the subset of patients with serum PSA levels of < 10 ng/mL. In summary, the pre-biopsy PLR is not an independent predictor of CSPCa at the prostate biopsy, regardless of the serum PSA level.

Neuroendocrine prostate cancer

Neuroendocrine prostate cancer (NEPC) mostly occurs as atreatment-emergent adaptive response under the pressure of intensive androgen deprivation treatment (t-NEPC). Approximately 30-40% of patients with metastatic castration-resistant prostate cancer (mCRPC) also have neuroendocrine involvement. In contrast primary small cell prostate cancer is very rare (<1%). A t‑NEPC should be clinically suspected in patients who have particularly aggressive mCRPC but a disproportionately low prostate-specific antigen (PSA) level and elevated neuroendocrine tumor markers, such as chromograninA and neuron-specific enolase. The initial Gleason score was shown to be an independent factor correlated to the risk of development of t‑NEPC. Treatment is oriented to that of small cell lung cancer. In patients with negative PSA levels, chemotherapy with cisplatin and etoposide is the first line treatment, for which response rates in the range of 30-60% with amedian survival time of usually less than 1year can be achieved. In patients with much higher serum PSA levels, chemotherapy with carboplatin plus docetaxel should be considered.

Neuroendocrine prostate cancer

Neuroendocrine prostate cancer (NEPC) mostly occurs as atreatment-emergent adaptive response under the pressure of intensive androgen deprivation treatment (t-NEPC). Approximately 30-40% of patients with metastatic castration-resistant prostate cancer (mCRPC) also have neuroendocrine involvement. In contrast primary small cell prostate cancer is very rare (<1%). A t‑NEPC should be clinically suspected in patients who have particularly aggressive mCRPC but a disproportionately low prostate-specific antigen (PSA) level and elevated neuroendocrine tumor markers, such as chromograninA and neuron-specific enolase. The initial Gleason score was shown to be an independent factor correlated to the risk of development of t‑NEPC. Treatment is oriented to that of small cell lung cancer. In patients with negative PSA levels, chemotherapy with cisplatin and etoposide is the first line treatment, for which response rates in the range of 30-60% with amedian survival time of usually less than 1year can be achieved. In patients with much higher serum PSA levels, chemotherapy with carboplatin plus docetaxel should be considered.

Meta-analysis of miRNA expression profiles for prostate cancer recurrence following radical prostatectomy.

BackgroundProstate cancer (PCa) is a leading reason of death in men and the most diagnosed malignancies in the western countries at the present time. After radical prostatectomy (RP), nearly 30% of men develop clinical recurrence with high serum prostate-specific antigen levels. An important challenge in PCa research is to identify effective predictors of tumor recurrence. The molecular alterations in microRNAs are associated with PCa initiation and progression. Several miRNA microarray studies have been conducted in recurrence PCa, but the results vary among different studies.MethodsWe conducted a meta-analysis of 6 available miRNA expression datasets to identify a panel of co-deregulated miRNA genes and overlapping biological processes. The meta-analysis was performed using the ‘MetaDE’ package, based on combined P-value approaches (adaptive weight and Fisher's methods), in R version 3.3.1.ResultsMeta-analysis of six miRNA datasets revealed miR-125A, miR-199A-3P, miR-28-5P, miR-301B, miR-324-5P, miR-361-5P, miR-363*, miR-449A, miR-484, miR-498, miR-579, miR-637, miR-720, miR-874 and miR-98 are commonly upregulated miRNA genes, while miR-1, miR-133A, miR-133B, miR-137, miR-221, miR-340, miR-370, miR-449B, miR-489, miR-492, miR-496, miR-541, miR-572, miR-583, miR-606, miR-624, miR-636, miR-639, miR-661, miR-760, miR-890, and miR-939 are commonly downregulated miRNA genes in recurrent PCa samples in comparison to non-recurrent PCa samples. The network-based analysis showed that some of these miRNAs have an established prognostic significance in other cancers and can be actively involved in tumor growth. Gene ontology enrichment revealed many target genes of co-deregulated miRNAs are involved in “regulation of epithelial cell proliferation” and “tissue morphogenesis”. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis indicated that these miRNAs regulate cancer pathways. The PPI hub proteins analysis identified CTNNB1 as the most highly ranked hub protein. Besides, common pathway analysis showed that TCF3, MAX, MYC, CYP26A1, and SREBF1 significantly interact with those DE miRNA genes. The identified genes have been known as tumor suppressors and biomarkers which are closely related to several cancer types, such as colorectal cancer, breast cancer, PCa, gastric, and hepatocellular carcinomas. Additionally, it was shown that the combination of DE miRNAs can assist in the more specific detection of the PCa and prediction of biochemical recurrence (BCR).ConclusionWe found that the identified miRNAs through meta-analysis are candidate predictive markers for recurrent PCa after radical prostatectomy.

Serum Prostate Specific Antigen level in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a common disorder in women in the reproductive age associated with disturbance of reproductive, endocrine and metabolic functions. The pathophysiology of PCOS appears to be multifactorial and polygenic.Objective: To measure the level of prostate –specific antigen (PSA) and to evaluate the value of prostatic specific antigen as a marker of hyperandrogenism in women with PCOS.Patients and Methods: One hundred women were entrolled in this study, 50 women were PCOS group and the remainder was healthy women served as control group. Hormonal profile (serum testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) levels were measured. Ferriman-Gallway Score (FGS) was assessed. Serum prostate specific antigen level was measured in both groups. Correlation between PSA level and (LH/FSH, testosterone and FGS) were evaluated.Result: Mean serum PSA level was significantly higher in PCOS women compared to control women (0.15+0.09, 0.016+0.003) respectively with P value &lt; 0.05 ). Serum PSA level in women with PCOS had significant positive correlation with FGS, LH/FSH ratio and serum testosterone with r values: 0.964, 0.988, 0.922 respectively. There was a strong correlation between serum PSA levels with the degree of hirsutism as evaluated by Ferriman –Gallway score . Serum PSA level in the 1st group ( 4-8 ) was 0.07+0.009, in the 2 nd group ( FGS9-12 ) was 0.1+0.06 and in the 3 rd group ( FGS 13-16 ) was 0.3+0.03 .Conclusion: Prostate – specific antigen level is significantly higher in women with PCOS and correlate positively with LH/FSH, testosterone and Ferriman-Gallway score. It is also concluded that the higher score of hirsutism correlate with the higher serum PSA level.

The likelihood of having serum level of PSA of ≥4.0 ng/mL and ≥10.0 ng/mL in non-obese and obese Nigerian men with LUTS

ObjectiveThis study was undertaken to determine the likelihood of having serum total prostate specific antigen (PSA) levels ≥4.0 ng/mL and ≥10.0 ng/mL among a cohort of non-obese and obese Nigerian men with lower urinary tract symptoms (LUTS). MethodsThis was a prospective cross-sectional survey among men who presented with benign prostatic hypertrophy to the urology clinic of the Ekiti State University Teaching Hospital, Ado -Ekiti with LUTS between January 1 and December 31, 2014. One hundred and forty men who presented in the urologic clinic with LUTS were recruited. PSA was analyzed using standard method while other clinical variables were collected using a clinical case form. Multivariate logistic regression was used to estimate the odds of an abnormal PSA of ≥4.0 ng/mL or ≥10.0 ng/mL in these men. ResultsThe mean ages of obese and non-obese men were 64.8 and 64.0 years respectively. The mean total serum PSA were 14.8 and 13.2 ng/mL for obese and non-obese men respectively. Univariate analysis showed no difference (p > 0.05) in the proportion of obese and non-obese men with LUTS who had a PSA threshold of at least 4.0 ng/mL. Multivariate logistic regression showed that, at a PSA threshold of 10.0 ng/mL, obese men had a statistically significant proportion (p < 0.05). Although not significant, non-obese patients were less likely to have PSA level of ≥4.0 ng/mL (OR 0.701; 95% CI 0.301–1.630) compared to obese men. In the same vein, non-obese men were less likely to have a PSA level of 10.0 ng/mL (OR, 0.686; 95% CI, 0.318–1.478) in a simultaneous context of age. ConclusionOur study demonstrated that, in a sample population of predominantly native African men, there was a non-significantly higher likelihood of overweight/obese patients having a higher serum PSA level than the non-obese. A community based study is needed to further confirm this finding.

Two Different Coagulopathy Episodes in a Single Patient with Metastatic Prostate Cancer

We reported a case of two different episodes of critical coagulopathy in a single patient with metastatic prostate cancer (mPC). The patient initially visited the emergency room with a huge left retroperitoneal hematoma, high serum prostate-specific antigen level, and signs of acute disseminated intravenous coagulation (DIC) from mPC. With blood product replacement and anti-androgen therapy, the DIC-related symptoms and signs were relieved. During the follow-up, he was treated with docetaxel chemotherapy for hormone refractory PC. Four years later, he visited the emergency room again with relapsed coagulopathy and severe anemia that were not replaced with blood products. The laboratory findings were consistent with thrombotic thrombocytopenic purpura rather than DIC. A satisfactory recovery was achieved with a new cycle of docetaxel chemotherapy. Differentiation of the coagulopathies in PC is difficult; therefore, we describe the different features of two overlapping coagulopathies, which will be helpful in deciding on urgent treatment.

Prostate-specific antigen-based population screening for prostate cancer: current status in Japan and future perspective in Asia.

In Western countries, clinical trials on prostate cancer screening demonstrated a limited benefit for patient survival. In the Asia-Pacific region, including Japan, the rate of prostate-specific antigen (PSA) testing remains very low compared with Western countries, and the benefits of population-based screening remain unclear. This review describes the current status of population screening and diagnosis for prostate cancer in Japan and discusses the efficacy of population screening for the Asian population. Since the 1990s, screening systems have been administered by each municipal government in Japan, and decreases in the prostate cancer mortality rate are expected in some regions where the exposure rate to PSA screening has increased markedly. A population-based screening cohort revealed that the proportion of metastatic disease in cancer detected by screening gradually decreased according to the increased exposure rate, and a decreasing trend in the proportion of cancer with high serum PSA levels after population screening was started. The prognosis of the prostate cancer detected by population screening was demonstrated to be more favorable than those diagnosed outside of the population screening. Recent results in screening cohorts demonstrated the efficacy of PSA. These recent evidences regarding population-based screening in Japan may contribute to establishing the optimal prostate cancer screening system in Asian individuals.

A study of biological determinants of serum prostate specific antigen level in prostatic adenocarcinoma with normal, borderline, and high serum PSA levels

Objectives: To find out the reasons for discrepancy in the serum prostate-specific antigen (PSA) values (normal, borderline, and high) in prostatic adenocarcinoma. Materials and Methods: It is a retrospective correlation study of serum PSA levels with the histomorphological variables and age of the patients in adenocarcinoma prostate with normal, borderline, and high serum PSA values. Age of the patients was noted down and hematoxylin and eosin-stained, paraffin-blocked sections were studied. Results: Serum PSA values were found to be directly related to histomorphological variables like Gleason grade and score, tumor cell mass to stroma ratio, necrosis, and cell size; but not with the age of the patients with prostatic adenocarcinoma. Discussion: Publications on relationship between serum PSA levels and Gleason grade and score in adenocarcinoma prostate are rarely found in the literature. Infarction (coagulation necrosis) increases serum value of PSA in benign prostatic tissue which can be true with carcinomas also, as in the present study. Various histomorphologic variables also may affect the serum PSA levels. The age of the patient and serum PSA levels in carcinoma prostate is not found directly proportional, in this study, unlike in normal individuals who show age-specific PSA ranges.

Decreasing trend in prostate cancer with high serum prostate-specific antigen levels detected at first prostate-specific antigen-based population screening in Japan.

To clarify the recent trends in prostate-specific antigen (PSA) distribution in men in Japan, we analyzed the PSA distributions of men undergoing PSA-based population screening. We summarized the annual individual data of PSA-based population screening in Kanazawa, Japan, from 2000 to 2011, and analyzed baseline serum PSA values of the participants at the first population screening. Serum PSA distributions were estimated in all participants and those excluding prostate cancer patients according to age. From 2000 to 2011, 19 620 men participated aged 54–69 years old in this screening program. Mean baseline serum PSA level of all participants at the first screening was 2.64 ng ml−1 in 2000, and gradually decreased to approximately 1.30 ng ml−1 in 2006. That of participants excluding prostate cancer patients was 1.46 ng ml−1 in 2000, and there was no remarkable change during the study period. The 95th percentiles in the participants excluding prostate cancer patients detected at the first population screening of men aged 54–59, 60–64, and 65–69 years old were 2.90, 3.60, and 4.50 ng ml−1, respectively. After the commencement of population screening, the proportion of prostate cancer patients with high serum PSA levels decreased. However, there were no changes in serum PSA levels in men without prostate cancer. Age-specific PSA reference level of men without prostate cancer in Japan was similar to that in China and Korea.

Detection of bone marrow metastases in prostate cancer: Role of trephine biopsy and Immunohistochemistry

Context: Bone marrow (BM) metastases are an integral part of tumor dissemination in many malignancies. Prostate carcinoma, which has high tendency to metastasize to bone, shown to have affinity for endosteal niche as well as tendency to compete with hematopoietic cells to home in BM. This marrow dissemination can be confidently proved by histopathological examination of BM. Aims: In this study, we are trying to detect the presence of metastases and micrometastases in BM of prostate carcinoma patients with the help of immunohistochemical markers prostate-specific antigen (PSA) and prostate-specific acid phosphatase and correlate the findings with American Joint Committee on Cancer Tumor, Node and Metastasis 7 th (2010) classification, serum PSA, and biopsy Gleason's score. Materials and Methods: We performed BM examination and hematological workup of 11 known prostate carcinoma patients including metastatic cases also, during our study period of 1 year. The BM biopsy sections and clot sections were used to carry out immunohistochemistry. The data were analyzed by using SPSS (Statistical Package for Social Sciences) version 15.0 statistical analysis software. Results: We found that two patients were positive for metastases in BM out of the 11. Both of these patients already had metastases to other site with very high serum PSA levels. Anemia was common hematological alteration in both of them and one of them showed increased osteoblasts in the aspirate film. Conclusion: Taking into account our small sample size and short study duration, we conclude that further large sized future studies with long-term follow-up in to this BM dissemination by prostate cancer cells could open new horizons to understand the biology of metastasis of this common malignancy and also provide more effective therapeutic options as well as prognostic implications in these patients.

Is further evaluation needed for incidental focal uptake in the prostate in 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography images?

The aim of this study was to investigate the frequency of secondary evaluation to detect prostate cancer that was primarily manifested as abnormal hypermetabolism detected by 18-fluoro-2-deoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT). We also evaluated the association of maximum standardized uptake values (SUVmax) on PET/CT with clinicopathologic results. We evaluated PET/CT reports from a total of 12,037 patients to find cases with abnormal prostate hypermetabolism. Patients with known prostate cancer or a recent prostate procedure were excluded. We analyzed the frequency of secondary evaluations such as digital rectal exams (DRE), levels of serum prostate-specific antigen (PSA), and/or biopsy to confirm prostate cancer. Biopsied patients were categorized into benign and cancer groups. Clinicopathologic characteristics were compared between the groups. Among 12,037 PET/CT images, 184 (1.5%) showed abnormal hypermetabolism in the prostate. Secondary evaluation was carried out in 120 patients. Biopsy was performed in 38 patients and prostate cancer was confirmed in 23 patients. The median serum PSA level was 3.2 and 49.7 ng/mL in the benign group and cancer group, respectively. The SUVmax was higher in the cancer group (5.7 ± 5.1) than in the benign group (4.8 ± 2.7), but the difference was not statistically significant (p = 0.37). In the cancer group, a high serum PSA level (≥ 20 ng/mL) was detected in 78.3% of the patients. The Gleason score was 7 in 34.7% and 8-10 in 56.5% of prostate cancer patients. Hypermetabolism in the prostate was incidentally detected in 1.5% of patients, and only 65.2% of these patients underwent further evaluation (DRE and/or serum PSA levels). Among cases of incidentally detected hypermetabolism in the prostate, patients with abnormal findings (DRE and/or PSA levels) showed high positivity by biopsy, and more than two-thirds of the positive biopsies showed significant prostate cancer. Therefore, patients with hypermetabolism in the prostate should not be ignored and should be secondarily evaluated by DRE and PSA level.

Circulating fibroblast‐like cells in men with metastatic prostate cancer

Metastatic prostate cancer is an incurable disease. During the development of this disease, prostate cancer cells enter the bloodstream as single cells or clusters of cells. Prostate fibroblasts, a cancer-promoting cell type in the prostate cancer microenvironment, could in theory incorporate into these migrating cell clusters or follow cancer cells into the bloodstream through holes in the tumor vasculature. Based on this idea, we hypothesized that fibroblast-like cells, defined here as cytokeratin 8/18/19(-) /DAPI(+) /CD45(-) /vimentin(+) cells, are present in the blood of men with metastatic prostate cancer. Veridex's CellSearch® system was used to immunomagnetically capture EpCAM(+) cells and clusters of cells heterogeneous for EpCAM expression from the blood of men with metastatic prostate cancer, localized cancer, and no known cancer, and immunostain them for the presence of cytokeratins 8/18/19, a nucleus, CD45, and vimentin. Fibroblast-like cells were then quantified. Fibroblast-like cells were present in 58.3% of men with metastatic prostate cancer but not in any men with localized prostate cancer or no known cancer. The presence of these cells correlated with certain known indicators of poor prognosis: ≥ 5 circulating tumor cells, defined here as cytokeratin 8/18/19(+) /DAPI(+) /CD45(-) cells, per 7.5 ml of blood, and a relatively high serum prostate-specific antigen level of ≥ 20 ng/ml. The presence of fibroblast-like cells in the blood may provide prognostic information as well as information about the biology of metastatic prostate cancer.