Normal Prostate-specific Antigen Levels Research Articles

Predictors of Successful Trial without Catheter in Acute Urinary Retention

Objectives: We aim to identify predictors of successful trial without catheter after an episode of acute urinary retention and to evaluate how serum prostate specific antigen (PSA) and C-reactive protein (CRP) levels behave during an acute urinary retention episode and also whether the PSA level is a useful indicator of undetected prostate cancer. Patients and methods: 335 patients presented to our institution in acute urinary retention from June 2006 to December 2007. After excluding females, patients with known prostate cancer, clot retention due to haematuria and catheter-related problems, 100 patients were entered into this prospective audit. On admission we documented serum PSA and CRP levels, residual urine volumes, urinary tract infection (UTI), digital rectal examination (DRE) and history of urinary tract surgery. The outcome of subsequent trial without catheter (TWOC) was documented. Where indicated, repeat serum PSA and CRP levels, transrectal ultrasound and prostate biopsies were obtained. Parametric and non-parametric tests were used for statistical analysis. Results: Median residual volume on catheterization was 750 mL. Successful TWOC was more likely in smaller sized prostates (Kendall tau-b, p = 0.004) and in benign feeling prostates (Fisher Exact Test, p = 0.004). TWOC failure was significantly higher in patients diagnosed with new prostate cancer (Fisher Exact Test, p = 0.032). Higher initial PSA levels, higher residual volumes and larger prostate size on DRE also resulted in higher TWOC failure rates. However these correlations were not statistically significant. UTI was confirmed in 13 of 100 patients on admission. Presence of UTI on admission had no influence on CRP or PSA levels, residual volumes or outcome of TWOC following treatment of UTI. Nine patients were diagnosed with prostate cancer of whom six had clinically significant cancer. On admission median serum PSA level was 7.0 ng/L (range 0.08–4624 ng/L) and median serum CRP level 21 mmol/L (range normal to 247 mmol/L). Serum PSA levels positively correlated with consecutive diagnosis of new prostate cancer. However when using 4 ng/L as the upper limit for normal PSA levels, sensitivity for detecting prostate cancer was 89%, specificity only 43% and positive predictive value 18%. Patients with a new diagnosis of prostate cancer had a high TWOC failure rate with eight of nine patients requiring re-catheterization. Neither PSA nor CRP levels were correlated with residual volumes, presence of UTI or prediction of TWOC outcome. Conclusions: Successful TWOC is more likely in smaller sized and benign feeling prostates. Neither PSA nor CRP levels help to predict TWOC outcome. Residual urinary volumes might be of little value in predicting TWOC outcome. Patients should therefore be given the ‘benefit of the doubt’ and offered TWOC regardless of large residual volumes. Patients presenting in AUR are at risk of harboring clinically significant prostate cancer. A high level of suspicion should remain especially in those with failed TWOC and normal DRE. Serum PSA is an unreliable marker to detect prostate cancer in this patient group. We therefore do not recommend opportunistic PSA screening during an AUR episode. CRP was not a good marker for prostatic infarction or inflammation.

Prostate‐specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy

To retrospectively review hypogonadal men receiving testosterone replacement therapy (TRT), and evaluate the changes in prostate-specific antigen (PSA) levels over an extended period, and thus evaluate the occurrence of prostate cancer, as a primary concern in treating late-onset hypogonadism (LOH) is the potential increased risk of prostate cancer; we also recorded the cardiovascular effects of TRT. In all, 81 hypogonadal men (mean age 56.8 years) were followed for a mean (range) of 33.8 (6-144) months after starting TRT. All men had a normal baseline PSA level before TRT and had routine laboratory investigations, including measurements of body mass index (BMI), haematocrit, lipid profile, and liver function tests (LFTs). Testosterone and PSA levels were assessed every 6-12 months. Patients with a biopsy-confirmed or recent history of prostatitis before treatment were excluded. TRT was discontinued in men who developed prostate cancer. Before and 36 months after treatment the total testosterone levels were 241.1 and 379.8 ng/dL (P < 0.05), respectively. Four men (4.9%) developed prostate cancer at a mean (range) of 32.5 (22-41) months after starting TRT. In men without prostate cancer (95.1%), PSA levels did not increase significantly at 1-year intervals for 5 years. There was no statistical difference in PSA level change from baseline to 36 months when patients without prostate cancer were stratified into groups according to age (< or =50, 55-65 and > or =70 years). In men with prostate cancer there was an increase in mean PSA level from baseline to 18 months of 1.8 ng/mL, and to 36 months of 3.2 ng/mL (P < 0.05). Total cholesterol improved from 203.8 to 166.6 mg/dL (P < 0.05) after 36 months of TRT; the BMI, haematocrit and LFTs did not change significantly. LOH is an increasingly prevalent disease characterized by a symptomatically low testosterone level, and TRT is effective in normalizing serum testosterone levels, providing a beneficial cardiovascular effect, and improving sexual function and overall quality of life. PSA levels remain stable after normalization of testosterone for > or =5 years, prostate cancer can be effectively diagnosed and treated in men taking TRT, and the incidence of prostate cancer among men with LOH on TRT is no greater than that in the general population.

Cancer of Unknown Primary Finally Revealed to Be a Metastatic Prostate Cancer: A Case Report

The vast majority of patients with metastatic prostate cancer present with bone metastases and high prostate specific antigen (PSA) level. Rarely, prostate cancer can develop in patients with normal PSA level. Here, we report a patient who presented with a periureteral tumor of unknown primary site that was confirmed as prostate adenocarcinoma after three years with using specific immunohistochemical examination. A 64-year old man was admitted to our hospital with left flank pain associated with masses on the left pelvic cavity with left hydronephrosis. All tumor markers including CEA, CA19-9, and PSA were within the normal range. After an exploratory mass excision and left nephrectomy, the pelvic mass was diagnosed as poorly differentiated carcinoma without specific positive immunohistochemical markers. At that time, we treated him as having a cancer of unknown primary site. After approximately three years later, he revisited the hospital with a complaint of right shoulder pain. A right scapular mass was newly detected with a high serum PSA level (101.7 ng/ml). Tissues from the scapular mass and prostate revealed prostate cancer with positive immunoreactivity for P504S, a new prostate cancer-specific gene. The histological findings were the same as the previous pelvic mass; however, positive staining for PSA was observed only in the prostate mass. This case demonstrates a patient with prostate cancer and negative serological test and tissue staining that turned out to be positive during progression. We suggest the usefulness of newly developed immunohistochemical markers such as P504S to determine the specific primary site of metastatic poorly differentiated adenocarcinoma in men.

Diagnosis of prostatitis by 18-F-fluorodeoxyglucose positron emission tomography.

A 74-year-old man, who underwent renal transplantation in April 2007 for end-stage renal failure caused by chronic glomerulonephritis, was admitted in August 2008 for fever (38.5°C) without orientation symptoms. He had history of essential hypertension, diabetes and ischaemic cardiopathy. The patient had presented two episodes of isolated fever in June 2007, with negative bacteriology, which responded to large spectrum antibiotics. He reported cloudy urines, but no mictalgia nor pelvic pain. Physical examination was unremarkable, and the renal transplant was not painful. Initial blood tests showed a high C-reactive protein (33 mg/dL), a white blood cell count of 18 000/μL (85% neutrophils) and a mild increase in plasma creatinine (1.6 mg/dL). There was no leucocyturia, but urine culture was positive for Enterococcus faecalis. The prostate-specific antigen (PSA) was normal at 0.14 ng/mL. Eight blood culture pairs remained sterile. Renal ultrasonography was unremarkable. An 18-F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scan revealed an intense prostatic fixation, compatible with prostate abscess (Figure ​(Figure1).1). The diagnosis was confirmed by painful digital rectal examination. Appropriate antibiotherapy was initiated, resulting in the disparition of fever and normalization of inflammation and renal function. Fig. 1 Coronal (A, C) and axial (B) sections of FDG PET (A) and FDG PET scan (B, C) showing the intense FDG uptake in the prostate (arrow), in addition to the normal captation in the brain and urinary bladder. The image indicates the presence of a prostate abscess, ... The association between fever and bacteriuria in a renal transplant recipient can be caused by transplant pyelonephritis or prostatitis. The diagnosis of prostatitis may be difficult in the absence of specific symptoms or with normal PSA levels [1,2] causing delay in treatment. In our patient, the PET scan focused intensely on the prostate, leading to the diagnosis of prostatitis despite normal PSA level. This case, the first documented in a renal transplant recipient, confirms the value of 18-FDG PET scan in a fever of unknown origin and, more precisely, in the diagnosis of bacterial prostatitis. The differential diagnosis of increased FDG uptake in the prostate includes inflammatory and malignant processes [3]. Conflict of interest statement. None declared.

Normal serum prostate specific antigen levels in men in Yasuj province, Islamic Republic of Iran

We assessed serum prostate specific antigen (PSA) levels in 650 men over 40 years referred to 3 Yasuj hospitals for blood cell count in 2003/2004. Men affected by prostate cancer, prostatitis or transurethral instrumentation were excluded. PSA was determined by an immunoassay technique. PSA levels in different age groups were: 40-49-year-olds--mean = 0.7 ng/dL, normal = 0-1.35 ng/dL; 50-59-year-olds--mean = 0.9 ng/dL, normal = 0-1.85 ng/dL; 60-69-year-olds--mean = 1.6 ng/dL, normal = 0-3.2 ng/dL; > or = 70-years-olds--mean = 2.3 ng/dL, normal = 0-4.4 ng/dL. Normal PSA levels in our society were lower than those in the United States, Europe and Japan.

Assessing Individual Risk for Prostate Cancer

To construct a clinical nomogram instrument to estimate individual risk for having prostate cancer (PC) for patients undergoing prostate specific antigen (PSA) screening, using all risk factors known for PC. We conducted a cross-sectional study of 3,108 men who underwent a prostate biopsy, including a subset of 408 volunteers with normal PSA levels. Factors including age, family history of PC (FHPC), ethnicity, urinary symptoms, PSA, free:total PSA ratio, and digital rectal examination (DRE) were incorporated in the model. A nomogram was constructed to assess risk for any and high-grade PC (Gleason score >or= 7). Of the 3,108 men, 1,304 (42.0%) were found to have PC. Among the 408 men with a normal PSA (< 4.0 ng/mL), 99 (24.3%) had PC. All risk factors were important predictors for PC by multivariate analysis (P, .01 to .0001). The area under the curve (AUC) for the nomogram in predicting cancer, which included age, ethnicity, FHPC, urinary symptoms, free:total PSA ratio, PSA, and DRE, was 0.74 (95% CI, 0.71 to 0.81) and 0.77 (95% CI, 0.74 to 0.81) for high-grade cancer. This was significantly greater than the AUC that considered using the conventional screening method of PSA and DRE only (0.62; 95% CI, 0.58 to 0.66 for any cancer; 0.69; 95% CI, 0.65 to 0.73 for high-grade cancer). From receiver operating characteristic analysis, risk factors including age, ethnicity, FHPC, symptoms, and free:total PSA ratio contributed significantly more predictive information than PSA and DRE. In a PC screening program, it is important to consider age, family history of PC, ethnicity, urinary voiding symptoms, and free:total PSA ratio, in addition to PSA and DRE.

High levels of serum prostate‐specific antigen due to PSA producing follicular non‐Hodgkin’s lymphoma

Both carcinoma of the prostate and non-Hodgkin's lymphoma are common in elderly patients. Measurement of serum prostate-specific antigen (PSA) is a frequently used tool to diagnose and monitor prostate carcinoma and is generally specific for diseases of the prostate. We describe a 68-yr-old patient with voiding difficulties and high PSA levels, but without inflammatory or malignant changes upon multiple transrectal ultrasound guided prostate biopsies. Digital rectal examination was normal. Laboratory showed a strongly elevated PSA level (62 microg/L, Immulight 2000); DPC, USA). A CT-scan showed a retroperitoneal process with mass in the right pelvis and infiltration of the bladder wall, suggestive for metastatic prostate carcinoma. Surgical excision of an axillary lymph node set the diagnosis at a stage IV follicular lymphoma, Berard grade I to II in which the majority of neoplastic cells expressed PSA. After lymphoma-specific treatment, there was a positron emission tomography (PET) confirmed complete remission with normal PSA levels (6 microg/L), which still persists. Although rare, high PSA levels can be due to the presence of non-Hodgkin's lymphoma. Such a diagnosis should be considered when patients present with lymphadenopathy other than regional prostatic lymphadenopathy.

Incidental diagnosis of a PSA-negative prostate cancer by 18FDG PET/CT in a patient with hypopharyngeal cancer

Diagnosis of prostate cancer (PC) still remains critical as non-invasive screening with prostate specific-antigen (PSA) lacks to indicate malignancy of the prostate in some cases. Recent research has shown that clinically meaningful PC can develop in patients with a PSA value <4 ng/ml, frequently defined as upper limit of normal serum PSA levels. Furthermore, both morphological (computed tomography (CT), magnetic resonance imaging, transrectal ultrasound) and functional imaging with (18)fluorodeoxyglucose positron emission tomography (FDG-PET) are associated with several limitations for primary diagnosis of PC. We report a case of an incidentally diagnosed PSA-negative PC by (18)FDG PET/CT in a patient with a previous diagnosis of a hypopharyngeal cancer.

The use of prostate‐specific antigen testing in men presenting with haematuria

To analyse prostate-specific antigen (PSA) levels and clinical outcome in men presenting with haematuria, to develop an evidence-base for the use of PSA testing in this setting, as haematuria is a known complication of locally invasive prostate cancer, and so PSA levels are often measured in patients presenting with haematuria. We reviewed the records of 637 men presenting with haematuria to our urology department between April 2002 and June 2005. Of 373 men aged 50-79 years, 278 (75%) had their PSA level measured, and 50 were abnormal. Prostate biopsies were taken in 27 men with an abnormal PSA level (54%) and one man with a normal PSA level but an abnormal digital rectal examination. Prostate cancer was detected in 22 patients (8% of those tested, and 71% of those biopsied); 4.7% of all men presenting with macroscopic haematuria and aged 50-79 years were found to have prostate cancer, vs 8.5% of those with microscopic haematuria. We report a higher proportion of prostate cancers in men presenting with haematuria and aged 50-79 years than reported in previous screening studies, and a cancer detection rate of 71% of those biopsied, which is at least double the detection rates seen in screening studies. In the absence of a prospective controlled trial, PSA testing will remain part of our protocol for both macroscopic and microscopic haematuria.

National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention

National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention

Establishing normal reference ranges for PSA change with age in a population‐based study: The Krimpen study

We aim to establish the normal pattern of prostate specific antigen (PSA) change with age to provide a baseline from which disease progression might be identified in prostate cancer patients included in active surveillance programs. In a community-based study, PSA values were determined at baseline and after 2.1 and 4.2 years in men without prostate cancer. A bivariate multilevel growth curve model was used to estimate the pattern of change of PSA with age. The final model showed that PSA was related to age only. The future PSA of an individual can be predicted based on his age and known history of PSA. The model was also used to calculate PSA doubling time for men with different PSA values at different ages. This method establishes normal PSA levels by age using PSA history in men without prostate cancer. The model provides baseline data from which disease progression might be detected.

Metastatic prostate cancer with a normal prostate-specific antigen level

Prostate-specific antigen (PSA) is the most commonly used tumour marker for prostate cancer, both in screening and in follow-up. However, there are many false positive increases in the presence of other prostate diseases and, currently, there is no consensus regarding sensitivity and specificity of the PSA test, nor what constitutes the upper limit of normality. We report a case of a 67-year-old patient with metastatic prostate cancer who, with increased level of alkaline phosphatase and normal PSA, showed clinical and radiological evidence of progression of the disease.

Prostate cancer metastasizing to bone with normal PSA level: a lesson to learn

Prostate cancer is the second most common cancer diagnosed in men and is increasingly being diagnosed as a result of the widespread use of prostate specific antigen (PSA) testing and patient awareness. PSA has found a role also in monitoring the response to treatment. Some poorly differentiated prostate cancers do not, however, secrete PSA, and they are consequently diagnosed later with a high incidence of metastases (Sella et al, 2000) and are difficult to follow in the absence of a known marker. The authors describe a case with development of metastases despite a normal PSA and discuss cautions that should be considered.

Prostate Cancer Presenting with Normal Serum PSA Levels and Boney Metastases Treated with Zoledronic Acid

Prostate specific antigen (PSA) is currently the most widely used tumor marker for diagnosing and monitoring prostate cancer. Serum PSA level greater than 10 ng/mL is considered a negative predictor for the presence of bone metastases and routine use of bone scans is therefore avoided. This report describes two cases of patients presenting with normal PSA levels (0-4 ng/ mL) and positive bone scans. The value of routine use of bone scintigraphy in the follow up of these cases is therefore questioned here. Moreover the addition of bisphosphonates to the androgen deprivation treatment, achieved not only pain relief and improvement in aspects of quality of life, but also provided radiographic evidence of management of metastatic bone disease.

Biochemical outcome after radical prostatectomy among men with normal preoperative serum prostate-specific antigen levels.

Recent studies have shown that a significant number of men with normal prostate-specific antigen (PSA) levels have prostate carcinoma. Whether malignancies in such men are associated with better outcomes is unclear. The authors compared the risk of biochemical failure after radical prostatectomy (RP) between men with normal PSA levels and men with elevated PSA levels. Data were examined from 1582 men who underwent RP between 1988 and 2002 at 1 of 5 equal-access medical centers. Patients were segregated into groups based on serum PSA levels (with stratification according to age-specific reference ranges). Clinical and pathologic characteristics and biochemical outcome data were compared across groups using analyses of variance, log-rank tests, and Cox proportional hazards analysis. Men who had normal PSA levels had significantly fewer high-grade tumors compared with men who had higher PSA levels (P < 0.001). The former group had a significantly decreased incidence of positive surgical margins, extracapsular disease, seminal vesicle invasion, and lymph node involvement (P < 0.001). On multivariate analysis, only serum PSA level (P < 0.001) and biopsy Gleason score (P < 0.001) predicted the time to disease recurrence. When only men with serum PSA levels < 10 ng/mL were examined, PSA level treated as a continuous variable remained a significant predictor of time to biochemical failure (P = 0.02). Men who had normal PSA levels had significantly fewer high-grade tumors and significantly better biochemical outcomes after undergoing RP compared with men who had elevated PSA levels. Overall, men with normal PSA levels who undergo RP represent a favorable risk group.

Prostate-Specific Antigen Levels and Density in the Internal and External Glands of the Prostate in Benign Prostatic Hyperplasia Patients with Normal or Gray-Zone PSA Levels

Objective: In patients with benign prostatic hyperplasia (BPH) showing normal prostate-specific antigen (PSA) levels (normal PSA group) and those with BPH showing gray-zone PSA levels (gray-zone PSA group), we assessed PSA levels secreted from the internal and external glands. Materials and Methods: We performed transurethral enucleation of the prostate (TUE) in 102 BPH patients with normal PSA and 59 BPH patients with gray-zone PSA at our department from 1999 to 2001. Preoperatively and approximately 6 months postoperatively, we measured serum PSA levels and determined prostatic volumes via transrectal ultrasonography (TRUS) to calculate PSA levels secreted from the internal and external glands as well as various PSA density (PSAD) values. Results: The total PSA level was 1.8 and 6.1 ng/ml in the normal and gray-zone PSA groups, respectively. The PSA level of the external gland was 0.6 and 0.8 ng/ml and the PSAD of the external gland was 0.07 and 0.08 ng/ml/cm³ in the normal and gray-zone PSA groups, respectively. The internal gland PSA was 1.3 and 5.4 ng/ml and the internal gland PSAD value was 0.11 and 0.30 ng/ml/cm³ in the normal and gray-zone PSA groups, respectively. Conclusions: Our results demonstrated that increased PSA levels in BPH cases with gray-zone PSA were attributable to increased PSA secreted from the internal gland rather than from the external gland. In our opinion, the determination of PSA and PSAD of the internal and external gland may be clinically significant in the future.

Free prostate-specific antigen improves prostate cancer detection in a high-risk population of men with a normal total PSA and digitalrectal examination

Objectives Uncertainty exists regarding optimal prostate cancer screening parameters for high-risk populations. The purpose of this study is to report the use of percent free prostate-specific antigen (PSA) as an indication for biopsy in men at increased risk for developing prostate cancer who have a normal digital rectal examination (DRE) and total PSA level between 2 and 4 ng/mL. Methods African-American men and men with at least one first-degree relative with prostate cancer are eligible for enrollment into the Prostate Cancer Risk Assessment Program (PRAP) at our institution. Between October 1996 and April 2002, 310 asymptomatic high-risk men with no history of prostate cancer, benign prostatic hyperplasia (BPH), or prostatic intraepithelial neoplasia (PIN) were screened in the PRAP with DRE and total PSA. Percent free PSA was obtained in men with a total PSA between 2 and 10 ng/mL. Men with a normal DRE and total PSA between 2 and 4 ng/mL were advised to undergo transrectal ultrasound-guided (TRUS) biopsies of the prostate if the percent free PSA was less than 27%. Other indications for biopsy included an abnormal DRE or a total PSA greater than 4 ng/mL. The primary endpoint evaluated was prostate cancer detection in high-risk men with a benign prostate examination, a normal total PSA between 2 and 4 ng/mL, and percent free PSA less than 27%. Results Of the 310 men, 174 (56%) were African American and 202 (65%) had at least one first-degree relative with prostate cancer. Sixty-two of the 310 men were referred for prostate biopsy, and 40 of 62 had biopsy performed. Twenty-one of 40 men were diagnosed with prostate cancer for a cancer detection rate of 53% in all men undergoing biopsy and an overall cancer detection rate of 6.8% in this high-risk population. Thirty-seven high-risk men (median age 54 years) with a total PSA level between 2 and 4 ng/mL (median 2.7 ng/mL) and a normal DRE were found to have a percent free PSA level of less than 27% (median 16%, range 8% to 25%). Twenty-three of these 37 men (62%) proceeded with the recommended prostate biopsy. Prostatic adenocarcinoma was diagnosed in 12 of 23 men for a cancer detection rate of 52% in men undergoing biopsy and 32% in all men with a normal DRE, a total PSA between 2 and 4 ng/mL, and a percent free PSA less than 27%. All positive biopsies demonstrated clinically significant Gleason score 6 or 7 disease. In all men electing radical prostatectomy, bilateral organ-confined disease (pT2bN0M0) was confirmed. Conclusions In this unique population of men at high risk for prostate cancer, a percent free PSA of less than 27% was found to be useful for detecting early-stage but clinically significant cancers in men with a total PSA value between 2 and 4 ng/mL and normal DRE findings.

Use of Percent Free Prostate-Specific Antigen Density to Improve the Specificity for Detecting Prostate Cancer in Patients with Normal Rectal Examinations and Intermediate Prostate-Specific Antigen Levels

Introduction: As prostatic volume influences percent free prostate-specific antigen (PSA) in patients with prostate cancer, we evaluated whether percent free PSA density, which relates the serum percent free PSA to the volume of the prostate determined by transrectal ultrasound, could increase the specificity of cancer detection in men with normal digital rectal examinations and intermediate PSA levels. Materials and Methods: We prospectively evaluated 105 consecutive men with normal digital rectal examinations and serum PSA levels of 4.1–10.0 ng/ml. All patients underwent at least sextant prostate biopsies to establish the diagnosis. For detection of total and free PSA we used an Immulite free and total PSA assay. We compared PSA density, percent free PSA and percent free PSA density for their utility in cancer detection. Results: Overall, 20 of 105 patients (19%) had prostate cancer. The area under the curve (AUC) for percent free PSA density was 0.771, not significantly higher than the AUC of 0.75 for PSA density (p = 0.778), but significantly higher than the AUC of 0.604 for percent free PSA (p = 0.021). Of these three parameters, percent free PSA density yielded the highest specificity percentage (54.1%) at 95% sensitivity. Conclusions: Percent free PSA density is more specific than percent free PSA in distinguishing benign from malignant disease in men with a normal digital rectal examination and an intermediate PSA level. Further study is necessary to discover whether percent free PSA density is superior to percent free PSA or PSA density.

Prevalence of undiagnosed prostate cancer in men with erectile dysfunction.

To explore the prevalence of prostate cancer in men presenting with erectile dysfunction (ED). In a prospective study, 127 men with ED of at least 6 months duration underwent screening for prostate cancer using prostate specific antigen (PSA) and a digital rectal examination (DRE). Men with a high PSA level (> 4 ng/mL) had sextant biopsies taken under sedoanalgesia. The serum testosterone level was measured in all the men. Twenty-six men were aged < 50 years and all had a normal PSA level; of 101 men aged > 50 years, 20 had an abnormal PSA. The detection rate for prostate cancer using PSA and DRE was 5%, which was not significantly higher than in the general population. All the detected cancers were clinically significant (> T2a, Gleason grade > 4). Two of the five men diagnosed with prostate cancer were Afro-Caribbean. Of the 127 men, 31% had a low serum testosterone level, but there was no association between testosterone and PSA levels. Prostate cancer is no more common in men with ED than in the normal male population. Therefore, routine screening for prostate cancer in men with ED is not indicated.

Correlation of histological inflammation in needle biopsy specimens with serum prostate- specific antigen levels in men with negative biopsy for prostate cancer

Objectives. To reveal the possible contribution of histological inflammation within the prostate to the abnormal elevation of serum prostate-specific antigen (PSA) levels in patients with needle biopsy negative for prostate cancer. Methods. We reviewed negative needle biopsy specimens obtained in 93 patients. The degree of acute and chronic inflammation as evaluated histologically was compared with serum PSA levels in conjunction with age and prostate volume. Results. Both age ( P <0.01) and prostate volume ( P <0.0001) correlated significantly with serum PSA levels and were significantly greater in patients with abnormal serum PSA levels (greater than 4.0 ng/mL) than in those with normal serum PSA levels (4.0 ng/mL or less) ( P <0.01). The presence of histological inflammation within the prostate also correlated significantly with serum PSA levels. Multiple regression analysis demonstrated prostate volume to be the only independent determinant of serum PSA levels ( P <0.01). In patients with a prostate volume larger than 25 mL, only prostate volume correlated significantly with serum PSA levels ( P <0.05). On the other hand, the degree of acute inflammation as represented by polymorphonuclear leukocyte infiltration was the only parameter correlating significantly with serum PSA levels ( P <0.05) in patients with a prostate volume smaller than 25 mL. Conclusions. Histologically defined acute inflammation within the prostate is a significant contributor to elevated serum PSA levels, especially in patients with small prostates. In the assessment of needle biopsy results negative for prostate cancer, it might be helpful to evaluate the degree of histological inflammation, especially in terms of the necessity of subsequent repeated biopsies.