Normal Serum Prostate-specific Antigen Research Articles

Urine Analysed by FTIR, Chemometrics and Machine Learning Methods in Determination Spectroscopy Markerof Prostate Cancer in Urine.

Prostate-specific antigen (PSA) is the most commonly used marker of prostate cancer. However, nearly 25% of men with elevated PSA levels do not have cancer and nearly 20% of patients with prostate cancer have normal serum PSA levels. Therefore, in this study, Fourier transform infrared (FTIR) spectroscopy was investigated as a new tool for detection of prostate cancer from urine. Obtained results showed higher levels of glucose, urea and creatinine in urine collected from patients with prostate cancer than that in control. Principal component analysis (PCA) was not noticed possibility of differentiation urine collected from healthy and nonhealthy patients. However, machine learning algorithms showed 0.90 accuracy and precision of FTIR in detection of prostate cancer from urine. We showed that wavenumbers at 1614 cm-1 and 2972 cm-1 were candidates for prostate cancer spectroscopy markers. Importantly, these FTIR markers correlated with Gleason score, PSA and mpMRI PI-RADS category.

Fourier transform InfraRed spectra analyzed by multivariate and machine learning methods in determination spectroscopy marker of prostate cancer in dried serum

Prostate cancer represents the second most prevalent form of cancer in males globally. In the diagnosis of prostate cancer, the most commonly utilised biomarker is prostate-specific antigen (PSA). It is unfortunate that approximately 25 % of men with elevated PSA levels do not have cancer, and that approximately 20 % of patients with prostate cancer have normal serum PSA levels. Accordingly, a more sensitive methodology must still be identified. It is imperative that new diagnostic methods should be non-invasive, cost-effective, rapid, and highly sensitive. Fourier transform infrared spectroscopy (FTIR) is a technique that fulfils all of the aforementioned criteria. Consequently, the present study used FTIR to assess dried serum samples obtained from a cohort of prostate cancer patients (n = 53) and a control group of healthy individuals (n = 40). Furthermore, this study proposes FTIR markers of prostate cancer obtained from serum. For this purpose, FTIR spectra of dried serum were measured and analysed using statistical, chemometric and machine learning (ML) algorithms including decision trees C5.0, Random Forest (RF), k-Nearest Neighbours (kNN) and Support Vector Machine (SVM). The FTIR spectra of serum collected from patients suffering from prostate cancer exhibited a reduced absorbance values of peaks derived from phospholipids, amides, and lipids. However, these differences were not statistically significant. Furthermore, principal component analysis (PCA) demonstrated that it is challenging to distinguish serum samples from healthy and non-healthy patients. The ML algorithms demonstrated that FTIR was capable of differentiating serum collected from both analysed groups of patients with high accuracy (values between 0.74 and 0.93 for the range from 800 cm−1 to 1800 cm−1 and around 0.70 and 1 for the range from 2800 cm−1 to 3000 cm−1), depending on the ML algorithms used. The results demonstrated that the peaks at 1637 cm−1 and 2851 cm−1 could serve as a FTIR marker for prostate cancer in serum samples. Furthermore, the correlation test indicated a clear correlation between these two wavenumbers and four of the five clinical parameters associated with prostate cancer. However, the relatively small number of samples collected only from patients over the age of 60 indicated that the results should be further investigated using a larger number of serum samples collected from a mean age range. In conclusion, this study demonstrated the potential of FTIR for the detection of prostate cancer in serum samples, highlighting the presence of distinctive spectroscopic markers associated with the analysed cancer type.

FDG PET/CT in a Case of Pure Ductal Adenocarcinoma of the Prostate With Osteolytic Metastases and Normal PSA Level.

Prostatic ductal adenocarcinoma is an uncommon aggressive subtype of prostate carcinoma. It is more likely to present with advanced stage and lower prostate-specific antigen. We describe FDG PET/CT findings in a case of pure prostatic ductal adenocarcinoma with lymph node, bone and lung metastases, normal serum prostate-specific antigen level, and elevated serum carbohydrate antigen 19-9 and carbohydrate antigen 724 levels. The primary tumor, and lymph node and bone metastases were hypermetabolic. All the bone metastases were osteolytic. The multiple lung metastases showed no significant FDG uptake, which may be due to small size.

A rare case of Leiomyosarcoma of the Prostate presenting with Recurrent Hematuria and Retention of Urine

Leiomyosarcoma of the prostate is an extremely rare aggressive tumor accounting for only 0.1-0.2% of all malignant prostatic tumors. About two hundred cases have been reported worldwide in the literature so far. There are no specific clinical features and imaging characteristics that can detect the condition, rather it is a histopathological and immunohistochemical diagnosis. So, a high degree of skepticism is needed in patients with hematuria, obstructive lower urinary tract symptoms with normal serum prostate specific antigen to detect the condition in time. Though there is no certain treatment modality for this condition, a multidisciplinary approach and aggressive management may benefit the patient. Here we report a case presented with recurrent episodes of hematuria, retention of urine and a history of transurethral resection of prostate multiple times which revealed benign prostatic hyperplasia. We have performed radical cystoprostatectomy of this patient which revealed Leiomyosarcoma of the Prostate. The patient was referred to clinical oncology for further management. But unfortunately, the patient died before receiving any systemic therapy. Bangladesh J. Urol. 2023; 26(1): 52-57

FDG PET/CT in a Case With Primary Poorly Differentiated Urothelial-Type Adenocarcinoma of the Prostate.

Primary urothelial-type adenocarcinoma of the prostate is extremely rare. We describe FDG PET/CT findings in a case with primary poorly differentiated urothelial-type adenocarcinoma of the prostate with pelvic lymph node metastases. Both the prostate tumor and its metastatic lesions showed intense FDG uptake. The patient had normal serum prostate-specific antigen and elevated carcinoembryonic antigen levels, which may be helpful for the differential diagnosis.

Rare presentation of metastatic adenocarcinoma of prostate as inguinal lymphadenopathy and its management

Prostate cancer is among the top ten cancers in India. Approximately half of patients with prostate cancer have metastasis on presentation, bones and regional lymph nodes being most common. A case of metastasised cancer of prostate presenting only with an inguinal mass without any other symptom is rare. A 72-year-old presented with a right inguinal mass for six months without any other complaints. Biopsy of the inguinal mass was done, and histopathology showed metastatic adenocarcinoma. His serum PSA (prostate specific antigen) was 117.325 ng/ml. PET CT (positron emission tomography-computed tomography) showed PSMA (prostate specific membrane antigen) expressing lesion in left lobe of prostate involving left seminal with metastatic pelvic, right inguinal, retroperitoneal and mediastinal adenopathy with increased tracer uptake in sclerotic skeletal lesions in right iliac bone, acetabulum and right femoral shaft. TRUS (trans rectal ultra-sonography) guided biopsy of prostate (12 CORE) was performed and showed conventional prostatic adenocarcinoma with maximum Gleason score 4+4=8, grade group IV. The patient's clinical stage was T3b N1 Mb. Patient is currently on abiraterone with degarelix with normal repeat serum PSA (0.067 ng/ml) on follow up at 5 months. Metastatic prostatic carcinoma usually presents with iliac nodes or bony metastasis, but rarely they present with inguinal lymphadenopathy and should be dealt with high clinical suspicion as they are already in advanced stage of the disease process.

Prostatic Ductal Adenocarcinoma Masquerading as a Rectal Mass: A Case Report

Abstract Objective The approach to a patient presenting with a rectal mass who has a history of bright red blood per rectum (BRBPR) renders a wide range of differential diagnoses. The clinical reasoning to suspect prostatic ductal adenocarcinoma (PDA) in a patient with BRBPR without a classical clinical presentation is highly unlikely. The incidence of PDA is rare with only 0.4% to 0.8% in pure ductal origin. Methods A 71-year-old African American male presented with 3-month history of watery, bloody diarrhea and a recent history of BRBPR with unintentional weight loss. Patient underwent colonoscopy, which showed a large polyp 10 cm from the anal verge, measuring 7 cm. The unclear history of this patient contributed to an initial impression of a colorectal cancer leading to a biopsy of the colonic mass. Results An erroneous diagnosis of tubulovillous adenoma was rendered initially. Further workup showed a large mass originating from the prostate area that was seen penetrating the colorectal region on an abdominal CT scan. The patient’s serum prostate-specific antigen (PSA) level was alarmingly high (4,800 ng/mL) and a subsequent prostate biopsy showed PDA. The colonic biopsy was reviewed again by a genitourinary pathologist and a correct diagnosis was rendered. Conclusion The role of pathology in diagnosing PDA is crucial as patients with PDA can have normal digital rectal examination (DRE) as well as a normal serum PSA level (less than 4.0 ng/mL). Majority of PDAs originate from periurethral prostatic ducts. The unique presentation of primary prostate pathology offers appreciation into the approach and workups to diagnose PDA. Diagnosing PDA can be challenging due to its more aggressive nature of PDA compared to prostatic acinar adenocarcinoma. The clinical reasoning and pathological findings from this rare case can aid clinicians and pathologists to establish the diagnosis of PDA in a timely and efficient manner.

Extensive Metastases in Prostatic Carcinoma with Normal Prostate-Specific Antigen and Raised Carcinoembryonic Antigen – Small Cell Carcinoma of Prostate: A Rare Entity

AbstractSmall cell carcinoma of prostate is a neuroendocrine tumor of prostate seen in 0.5%–2% of men with carcinoma prostate. Prostate-specific antigen (PSA) is a common tumor marker which is often raised in prostatic carcinoma. However, prostatic carcinoma can progress with normal or low serum PSA levels at the time of diagnosis. Carcinoembryonic antigen (CEA) is a tumor marker of different carcinomas. Small cell carcinoma prostate is a highly aggressive tumor which can progress with normal or low serum PSA levels and raised CEA levels. We report a case of 65-year-old male with enlarged prostate with extra-prostatic spread, hepatic metastases, metastatic retroperitoneal and pelvic lymph nodes, osteoblastic metastasis in lumbar spine with normal serum PSA, and raised CEA levels. Prostatic biopsy was suggestive of small cell carcinoma.

Age-specific Serum Prostate Specific Antigen Ranges Among Apparently Healthy Nigerian Men Without Clinical Evidence of Prostate Cancer.

Introduction:Serum prostate specific antigen (PSA) levels increase with age and varies among different races and communities. The study was aimed at defining the age-specific reference ranges of serum PSA in our environment.Methods:We evaluated the relationship between age and serum PSA levels and the age-specific reference ranges of serum PSA among civil servants in Lagos, who underwent routine medical checkups. Criteria for inclusion were men who have no lower urinary tract symptoms, normal digital rectal examination and serum PSA ≤ 20 ng/ml. SPSS Statistic 21 was used for data evaluation and the mean, median, 95th percentile PSA levels were estimated. Pearson's correlation was used to examine the relationship, and P < 0.05 was considered significant.Results:4032 men met the criteria for inclusion in the evaluation. The mean age was 51.6 (range 40–70) years, and there was a strong correlation between serum PSA levels and age (r = 0.097, P < 0.001). PSA ranges of 0–2.5, >2.5–4.0, >4.0–10, and >10 ng/ml were found in 3218 (80%), 481 (12%), 284 (7%), and 52 (1%) men, respectively. The mean, median and the 95th percentile PSA for the overall group were 1.84, 1.33, and 5.2 ng/ml respectively. However the 95th percentile PSA levels for men aged 40–49, 50–59, and 60–70 years were 4.78, 5.47, and 8.93 ng/ml respectively.Conclusion:The age-specific PSA levels among Nigerian men for each age group is higher than what was described for men in the Western world. These reference ranges of serum PSA should be considered for men aged ≥40 years in our environment.

Recurrent Prostate Cancer Presenting as Multiple Lung Metastases with a Low Serum Prostate-specific Antigen Level 5 Years after Prostatectomy: A Case Report

Prostate-specific antigen (PSA) is a glycoprotein produced by prostatic duct and acinar epithelial cells and the most commonly used marker for diagnosing prostate cancer, and for monitoring its progression and recurrence. Here, we describe a 76-year-old patient with recurrent prostate cancer who developed isolated hematogenous pulmonary metastases with a normal serum PSA level 5 years after radical prostatectomy. Immunohistochemical (IHC) analysis of a transbronchial lung biopsy specimen revealed tumor cells positive for PSA and prostatic acid phosphatase. After 2 months of maximal androgen blockade, the metastatic pulmonary nodules showed near-complete regression. In conclusion, metastases of prostate adenocarcinoma may occur despite low serum PSA levels, and, if warranted clinically, IHC staining or other serological markers for prostate adenocarcinoma should be considered when evaluating metastatic carcinoma from an unknown primary lesion in males with low serum PSA levels. (Korean J Med 2015;89:238-242)

Sex steroids in relation to sexual and skeletal maturation in obese male adolescents.

Childhood obesity is associated with an accelerated skeletal maturation. However, data concerning pubertal development and sex steroid levels in obese adolescents are scarce and contrasting. To study sex steroids in relation to sexual and skeletal maturation and to serum prostate specific antigen (PSA), as a marker of androgen activity, in obese boys from early to late adolescence. Ninety obese boys (aged 10-19 y) at the start of a residential obesity treatment program and 90 age-matched controls were studied cross-sectionally. Pubertal status was assessed according to the Tanner method. Skeletal age was determined by an x-ray of the left hand. Morning concentrations of total testosterone (TT) and estradiol (E2) were measured by liquid chromatography-tandem mass spectrometry, free T (FT) was measured by equilibrium dialysis, and LH, FSH, SHBG, and PSA were measured by immunoassays. Genital staging was comparable between the obese and nonobese groups, whereas skeletal bone advancement (mean, 1 y) was present in early and midadolescence in the obese males. Although both median SHBG and TT concentrations were significantly (P < .001) lower in obese subjects during mid and late puberty, median FT, LH, FSH, and PSA levels were comparable to those of controls. In contrast, serum E2 concentrations were significantly (P < .001) higher in the obese group at all pubertal stages. Obese boys have lower circulating SHBG and TT, but similar FT concentrations during mid and late puberty in parallel with a normal pubertal progression and serum PSA levels. Our data indicate that in obese boys, serum FT concentration is a better marker of androgen activity than TT. On the other hand, skeletal maturation and E2 were increased from the beginning of puberty, suggesting a significant contribution of hyperestrogenemia in the advancement of skeletal maturation in obese boys.

The clinic-pathological characteristics of prostate cancer in an Irish subpopulation with a serum PSA less than 4.0ng/ml

Background: Prostate specific antigen (PSA) has been used as a biomarker for prostate cancer for the last 20 years. Traditionally, a serum PSA &lt;4 ng/ml has been used as a general cut-off between normal and abnormal readings. There is evidence to demonstrate that men with a normal serum PSA can develop prostate cancer. The aim of this study was to investigate the clinico-pathological features of prostate cancer in a non-screened Irish cohort with serum PSA &lt;4 ng/ml. Methods: A retrospective analysis was performed of all patients who underwent radical retropubic prostatectomy (RRP) in a tertiary referral unit over a 10-year period (2000–2010). Clinico-pathological characteristics were collated including those from trans-rectal ultrasound-guided (TRUS) prostate biopsies and radical prostatectomy specimens. Results: Between 2000 and 2010, 651 men underwent an RRP, with 43 (6.6%) having a serum PSA &lt;4 ng/ml. The median PSA was 3.2 ng/ml (range 0.8–4.0). Nineteen (44.2%) had palpable disease on direct rectal examination (DRE). Following prostatectomy, 28 (65.12%) had Gleason 6 disease, 14 (32.56%) had Gleason 7 disease and one (2.32%) had Gleason 8 disease. Five (11.63%) patients were upgraded from TRUS biopsy to final histopathology. Six (13.95%) patients had pathological evidence of extracapsular extension on final pathology. Three (6.98%) patients experienced biochemical recurrence and received salvage radiation therapy after a median time of 24 months. The median follow-up was 106 months (range 36–158). Twenty (46.51%) patients had a first-degree family history of prostate cancer. Conclusions: A PSA cut-off of 4 ng/ml has commonly been used in the detection of prostate cancer. Our study emphasizes that this cut-off is inappropriate and that no specific level of PSA can be used. Management decisions need to be individualized based on index of suspicion with concomitant counselling and rectal examination.

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.

Abstract C32: Associations between systemic inflammatory markers and elevated serum prostate specific antigen in men with no evidence of prostatic disease

Abstract Introduction: Systemic inflammation has been reported to be associated with progression and poorer survival for cancer of several sites, including prostate cancer. However, its relationship with cancer risk remains inconclusive. We investigated the associations between systemic inflammatory and oxidative stress markers and serum prostate specific antigen (PSA) in a cohort of presumably healthy men without any prostatic disease, aged &amp;gt;= 40 years, who participated in the U.S. National Health and Nutrition Examination Survey (NHANES), 2002-2008 (n=4,069). Methods: Serum total PSA levels and concentrations of systemic inflammatory (serum C-reactive protein [CRP], plasma fibrinogen, neutrophil count, lymphocyte count, and platelet count) and oxidative stress markers (uric acid, vitamin C, and vitamin A) were recorded. Neutrophil-lymphocyte ratio (NLR) ratio and platelet-lymphocyte (PLR) ratio were calculated. Student's t-test was used to examine whether there was any difference in the log-transformed mean of each marker between normal (&amp;lt; 4 ng/mL) versus elevated serum PSA (&amp;gt;=4 ng/mL). Logistic regression analyses were conducted to examine the association between each marker and serum PSA by calculating the odds ratio (OR) and 95% confidence interval (CI). Results: Of the 4,069 men, 259 (6.4%) of them had an elevated serum PSA (&amp;gt;=4 ng/mL). Men with elevated serum PSA had significantly higher geometric mean levels of serum CRP, plasma fibrinogen, NLR, and PLR compared to men with normal serum PSA (p-values &amp;lt;0.01). Elevated serum PSA was positively associated with plasma fibrinogen (OR= 1.79; 95% CI, 1.18-2.71) and NLR (1.17; 95% CI, 1.05-1.29), after adjustment for age, smoking, body mass index, education, race, and medications. Conclusions: Fibrinogen and NLR were associated with elevated serum PSA in men without any prostatic disease. These markers may play a role in prostate cancer risk. Future studies are needed to examine fibrinogen's and NLR's relationship with prostate cancer progression. Citation Format: Alicia C. McDonald, Manish Vira, Stephen J. Freedland, Adriana C. Vidal, Wenqi Gan, Emanuela Taioli. Associations between systemic inflammatory markers and elevated serum prostate specific antigen in men with no evidence of prostatic disease. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C32.

Incidental Focal (18)F-FDG Uptake in the Prostate: Clinical Significance and Differential Diagnostic Criteria.

The extent and intensity of (18)F-FDG uptake in prostate cancer patients are known to be variable, and the clinical significance of focal (18)F-fluorodeoxyglucose ((18)F-FDG) uptake that is incidentally found on positron emission tomography (PET) has not been established. We investigated the clinical significance of incidental focal prostate uptake of (18)F-FDG on PET/computed tomography (CT) and analyzed differential findings on PET/CT between malignant and benign uptake. A total of 14,854 whole-body (18)F-FDG PET/CT scans (4,806 that were conducted during cancer screening and 10,048 that were conducted to evaluate suspected or allegedcanceroutside of the prostate) were retrospectively reviewed to determine the presence, location, multiplicity and maximum standardized uptake value (SUVmax) of focal prostate uptake and combined calcification. The final diagnosis determined by serum prostate-specific antigen (PSA) level and biopsy was compared with PET findings. Incidental focal prostate uptake was observed in 148 of 14,854 scans (1.0 %). Sixty-seven of these 148 subjects who had diagnostic confirmation were selected for further analysis. Prostatecancer was diagnosed in nine of 67 subjects (13.4%). The remaining 58 subjects had no malignancy in the prostate based on normal serum PSA level (n = 53), or elevated serum PSA level with a negative biopsy result (n = 5). While 84.6% (11/13) of malignant uptake was peripherally located in the prostate glands, 60.2% (50/83) of benign uptake was centrally located (p < 0.05). The positive predictive value of peripheral focal uptake for malignancy was 25%. The SUVmax, multiplicity andcombined calcification were not significantly different between the two groups. Although incidental focal (18)F-FDG uptake in the prostate is not common, the incidence of cancer with focal uptake is not low. Therefore, these findings deserve further evaluation. The location of the focal prostate uptake may help with the selection of high-risk prostate cancer patients.

Abstract 2843: Caspase-8 gene SNPs in prostate cancer susceptibility: a replication study

Abstract Introduction A single nucleotide polymorphism (SNP) in the caspase-8 gene, (CASP8 D302H), has been reported to be involved in susceptibility to breast and pancreatic cancer, melanoma and glioma, but not colorectal or ovarian cancer. We previously have used a tagging-SNP approach to test the hypothesis that this SNP, or other variants in CASP8, were associated with prostate cancer, in 1009 cases, 987 men with normal serum prostate specific antigen (PSA) levels and 961 men with low serum PSA (&amp;lt;0.5ng/ml). These subjects were drawn from those participating in the UK ProtecT (Prostate Testing for Cancer and Treatment) trial. Of the 15 tagging SNPs in caspase-8 that were genotyped, 7 showed some evidence of association with prostate cancer (P&amp;lt;0.05). The aim of the present study was to attempt to replicate these results in an independent set of case and control subjects. Methods A further independent sample of men from the ProtecT trial formed the replication cohort for this study. Blood DNA samples were available for 1262 men with prostate cancer, 1258 men with normal serum PSA, and 609 men with low serum PSA. SNP genotyping was carried out by 5-prime nuclease PCR (TaqmanTM, Applied Biosystems). The association with prostate cancer was tested using logistic regression, controlling for sample set. Results Two SNPs with duplicate concordance rates of less than 98% were not included in the analysis. Genotype call rates for the remaining 5 SNPs were all greater than 95%, and genotype frequencies in control subjects were consistent with those expected under Hardy-Weinberg equilibrium. None of the 5 SNPs yielded significant evidence of association in the replication cohort, although some odds ratios were consistent between the two data sets. We combined the data from the test and replication cohorts to evaluate the overall evidence for association. The rare alleles of rs3769826 and rs6723097 conferred a reduced risk of prostate cancer with per-allele odds ratios (95% confidence interval) [OR(95%CI)] of 0.90 (0.82-0.98) and 0.88 (0.80-0.96), and P=0.013 and P=0.004 respectively. In addition, the deletion allele of the promoter indel rs3834129 conferred an increased risk of prostate cancer, with OR (95%CI) of 1.15 (1.05-1.27), P=0.003. While these results await further replication, it is interesting to note that the rare alleles of rs3769826 and rs6723097 are carried on European haplotypes that are associated with increased risk of breast cancer, suggesting the possibility of a different mode of action of caspase-8 in the two tumour types. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2843.

Oxidative DNA Damage in the Prostate May Predispose Men to a Higher Risk of Prostate Cancer

DNA damage has been associated with prostate cancer risk. Men who were referred for initial prostate biopsy for elevated prostate-specific antigen or abnormal digital rectal examination are often found with no cancer but have a higher risk of developing prostate cancer than the general population of men in their lifetime. In this study, we investigated whether DNA damage is one of the factors that predispose these men referred for prostate biopsies to a higher risk of prostate cancer. We found significantly elevated levels of 8-oxo-2-deoxyguanosine immunoreactivity in the prostates of the referred men (n = 50) in comparison to the control prostates of men (n = 32) with no indication for referral for prostate biopsy. Twelve of these control men were healthy middle-aged men and 20 of them were older men whose conditions were diagnosed with bladder cancer but with normal serum prostate-specific antigen and digital rectal examination and no evidence of prostate disease. In all the 8-oxo-2-deoxyguanosine-positive prostates, we detected phosphorylation of the ataxia telangiectasia mutated kinase and expression of the immune-stimulatory molecule MIC in the prostate epithelium. These data suggest that: 1) oxidative DNA damage has occurred in the “referred” but pathologically normal prostates, indicating that these prostates may be subjected to genomic instability and eventually neoplastic transformation; 2) in response to DNA damage, two surveillance pathways, represented by ataxia telangiectasia mutated phosphorylation and induction of the NKG2D ligand MIC, were activated to prevent tumorigenesis.

Clinical utility of the interaction between lectin and serum prostate specific antigen in prostate cancer

The present investigation was a lectin-based diagnosis of malignant prostate cancer (PC) by the interaction of phytohemagglutinin (PHA lectin) from Phaseolus vulgaris with the glycan part of serum prostate specific antigen (PSA) of patients with prostatic disorder. This was confirmed by the interaction between PHA and purified PSA obtained from serum by electrophoretic separation and finally by HPLC chromatography. The precipitate of carbohydrate content after binding of PHA with purified PSA of PC was significantly higher than that of benign prostate hyperplasia (BPH) and/or normal serum PSA. The results suggest that there may be a striking difference in glycosylation pattern of PSA between BPH and PC. The cut off value > or = 10 microg/ml of the carbohydrate content of PHA-PSA precipitate indicates strong suspicion for PC irrespective of total serum PSA cut off level > or = 4.0 ng/ml by conventional immunoassay method and this may be taken as a guideline in differentiating PC and BPH. Key words: prostate cancer, BPH, PSA, lectin.

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.

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.