Prostate Specific Antigen In Diagnosis Research Articles

The Diagnostic Accuracy of Prostate-Specific Antigen and Digital Rectal Examination in the Diagnosis of Prostate Cancer at the University of Benin Teaching Hospital.

To assess and compare the diagnostic accuracy of prostate-specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of prostate cancer. It was a prospective, comparative study carried out over a period of 14 months at the University of Benin Teaching Hospital, Benin City. It involved male patients ≥50 years who presented at the urology clinic with lower urinary tract symptoms (due to prostatic disease), PSA > 4 ng/mL and or abnormal DRE findings. They had serum total PSA determined. Patients were recruited for prostate biopsy and samples sent for histopathological assessment. Histopathology was determined by a histopathologist dedicated to the study. Using a researcher-administered, structured proforma, data were collected, collated and subjected to statistical analysis for assessment and comparative analysis of the diagnostic accuracy of PSA and DRE. The study involved 94 patients; they were all Nigerians. The age range of the study population was 50-85 years, with a mean age of 70.4 ± 8.6 years. Most (89.4%) of the patients were exposed to formal education. PSA of the study population ranged between 2.5 and 840 ng/mL. For patients with carcinoma of the prostate (CaP), median PSA value was 79.2 ng/mL, whereas patients with benign prostatic disease had a median PSA value of 16.0 ng/mL. The difference in median PSA value between the two groups was statistically significant (P < 0.001). In this study, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of PSA was 97.2%, 12.1%, 40.7%, 87.5% and 44.7%, respectively. However, a sensitivity, specificity, PPV, NPV and diagnostic accuracy of DRE was 88.9%, 70.7%, 65.3%, 91.1% and 77.7%, respectively. Combination of PSA and DRE had sensitivity, specificity, PPV, NPV and diagnostic accuracy of 91.7%, 91.4%, 86.8%, 94.6% and 91.5%, respectively. In this study, 36 (38.3%) patients had CaP whereas 57 (60.6%) patients had benign prostatic disease and 1 (1.1%) patient had high-grade prostatic intraepithelial neoplasia. The study revealed a low specificity, high sensitivity and low diagnostic accuracy of PSA in diagnosis of CaP. However, sensitivity, specificity, and diagnostic accuracy of DRE were high but not sufficient in diagnosis of CaP. A combination of PSA and DRE had a higher sensitivity, specificity and diagnostic accuracy in diagnosis of prostate cancer.

Identification of a novel non-invasive biological marker to overcome the shortcomings of PSA in diagnosis and risk stratification for prostate cancer: Initial prospective study of developmental endothelial locus-1 protein

This prospective study sought to clarify the developmental endothelial locus-1 (Del-1) protein as values of diagnosis and risk stratification of prostate cancer (PCa). From February 2017 to December 2019, a total 458 patients who underwent transrectal ultrasound guided prostate biopsy or surgery of benign prostatic hyperplasia agreed to research of Del-1 protein. We prospectively compared and analyzed the Del-1 protein and prostate specific antigen (PSA) in relation to the patients' demographic and clinicopathological characteristics. Mean age was 68.86±8.55 years. Mean PSA and Del-1 protein was 21.72±89.37, 0.099±0.145, respectively. Two hundred seventy-six (60.3%) patients were diagnosed as PCa. Among them, 181 patients underwent radical prostatectomy (RP). There were significant differences in Del-1 protein between benign and PCa group (0.066±0.131 vs 0.121±0.149, respectively, p<0.001). When we set the cut-off value of del-1 protein as 0.120, in patients with 3≤PSA≤8, positive predictive value and specificity of Del-1 protein (≥0.120) for predicting PCa were 88.9% (56/63) and 93.5% (101/108), respectively. Among 181 patients who underwent RP, there were significant differences in Del-1 protein according to stage (pT2 vs pT3a vs ≥pT3b) (0.113±0.078, 0.171±0.121, 0.227±0.161, respectively, p<0.001) and to Gleason score (6 (3+3) or 7 (3+4) vs 7 (4+3) or 8 (4+4) vs 9 or 10) (0.134±0.103, 0.150±0.109, 0.212±0.178, respectively, P = 0.044). Multivariate analysis showed that PSA, Del-1 protein and high Gleason score (≥9) were the independent prognostic factors for predicting higher pT stage (≥3b). Furthermore, age, PSA and Del-1 protein were independent prognostic factors for predicting significant PCa. Patients with PCa showed higher expression of Del-1 protein than benign patients. Del-1 protein increased with the stage and Gleason score of PCa. Collaboration with PSA, Del-1 protein can be a non-invasive useful marker for diagnosis and risk stratification of PCa.

The Value of P504s, 34βE12, Ki-67 and PSA in Diagnosis and Prognosis of Prostate Cancer

Background: In recent years, the incidence of prostate cancer (PCa) is increasing. Advanced PCa has a poor prognosis and high cost, which seriously affects the quality of life of patients. Therefore, how to improve the diagnosis rate and prognosis of early PCa is the focus of clinical research. This paper aims to investigate the value of P504s, 34βE12, Ki-67 and prostate-specific antigen (PSA) in the diagnosis and prognosis of PCa.&#x0D; Objective: To investigate the expression of P504s, 34βE12, Ki67 and PSA in prostate tissues and their clinical significance.&#x0D; Methods: Twenty four cases in the study group were selected from PCa confirmed by pathology in the urology department of Chengde Affiliated Hospital from October 2018 to August 2020, and 33 cases of Benign Prostate Hyperplasia (BPH) confirmed by pathology in the same period were selected as the control group. The expression of P504s, 34βE12 and Ki-67 in prostate tissues were determined by immunohistochemistry.&#x0D; Results: The positive expression rates of P504s, 34βE12 and TPSA or F/TPSA in PCa patients were 95.8%, 12.5% and 87.5%, respectively. The positive rates in BPH patients were 9.1%, 93.9% and 27.3%. The difference between the two groups was statistically significant (p&lt;0.05). PCa bone or lymph node metastasis was positively correlated with Ki-67 (r=0.423, p&lt;0.05) and Gleason score (r=0.446, p&lt;0.05), indicating a stronger correlation with Gleasonscore.&#x0D; Conclusion: The combined detection of P504s, 34βE12 and PSA is helpful for the diagnosis and differential diagnosis of PCa. High Gleason score and ki-67 expression may indicate high risk of PCa metastasis and poor prognosis.

The Value of Prostate-Specific Antigen in Diagnosis of Polycystic Ovarian Syndrome in Adolescent Girls.

This study was designed to evaluate and compare the serum total prostate-specific antigen (PSA) levels in adolescent girls in with and without polycystic ovarian syndrome (PCOS) to show whether evaluation of PSA levels have a diagnostic benefit over existing diagnostic criteria. Case-control study. A territory referral center. A total of 89 (15-19years) nonobese (body mass index, 18-24.9) adolescents with PCOS (n=42) and controls without PCOS (n=47) were enrolled in the study. Pathophysiological features of PCOS and serum total PSA levels were determined at the time of study enrollment. Determination, comparison, and diagnostic performance of serum total PSA levels in diagnosis of PCOS in adolescent girls were the main outcome measures of the study. The serum total PSA levels of adolescents with PCOS were detected to be higher than for control participants (0.63±1.38ng/mL vs 0.48±0.95ng/mL) without meeting statistical significance (P=.923). There was a correlation between total PSA levels and indices of insulin resistance like the homeostasis insulin resistance model (r=0.414; P=.010). The serum total PSA level was not a discriminative parameter for diagnosis of PCOS in adolescent girls (area under the curve, 0.559; P=.476). The serum total PSA level was not a predictor of PCOS in adolescent girls. This finding might be related to the extemporal nature of tissues capable of PSA production and lack of sufficient exposure interval to hyperandrogenemia, rather than lack of stimulatory relationship between serum androgens.

Value of PI-RADS v2 scores combined with prostate specific antigen in diagnosis of peripheral zone prostate cancer: a logistic regression analysis

To assess the value of Prostate Imaging and Reporting and Data System: Version 2 (PI-RADS v2) combined with prostate specific antigen (PSA) in the diagnosis of peripheral zone (PZ) prostate cancer (PCa). The preoperative magnetic resonance imaging and PSA data were ananlyzed for 69 patients with pathologically confirmed PCa and 109 non-PCa patients. PI-RADS v2 scores (1-5) was used to evaluate the risk of PZ PCa. The total PSA (tPSA) level, free to total PSA ratio (f/t PSA), PSA density (PSAD), PZ-PSAD and PI-RADS v2 scores were compared between the PCa and non-PCa patients. Logistic regression models were established with parameters that differed significantly the two groups. The receiver opearting characteristics (ROC) curve was constructed based on the P values derived from the logical regression models and PI-RADS scores to assess the diagnostic efficiency. PI-RADS v2 score, tPSA, f/t PSA, PSAD and PZ-PSAD differed significantly between the two groups (P<0.01). Four predictive multivariate models were established: Logit P=-6.825+1.024PI-RADS v2+ 0.223tPSA (A), Logit P=-4.354+1.586PI-RADS v2-12.7841f/tPSA (B), Logit P=-8.993+1.630PI-RADS v2+17.091PSAD (C), and Logit P=-9.434+1.596PI-RADS v2+10.494PZ-PSAD (D), whose area under the ROC curves was 0.908, 0.891, 0.944, and 0.961, respectively, all significantly greater than that of PI-RADS v2 score (P<0.05). Compared with PI-RADS v2 score alone, the combination of PI-RADS v2 score and PSA in the logistic regression model can improve the diagnostic efficiency of PZ PCa and offers better confidence in the decision of biopsy in suspected cases.

Specificity and sensitivity of preoperative total serum prostate specific antigen in diagnosis most common histopathological change of prostate

Determination of preoperative prostate-specific antigen (PSA) value is primary procedure in diagnosis of different pathological prostate changes (prostate cancer-PC, prostatic intraepithelial neoplasia-PIN and benign prostatic hyperplasia-BPH), followed by digital rectal examination and prostate biopsy as gold standard. Disadvantage of high sensitivity and low specificity of PSA testing in diagnosis of PC is a problem in clinical practice. Aim was to determine the diagnostic performance of PSA in diagnosis of PC, PIN and BPH. The study included 100 patients divided into three groups: 70 with PC, 20 with a PIN and 10 with BPH. Patients with PIN and BPH were control group. Preoperative PSA values were determined by Tandem-R, The patients were divided into subgroups by baseline PSA level as follows: 4-10, 11-20, 21-30, 31-40 and> 40. The definitive histopathological diagnosis was made on routine hematoxylineosin slides. The area under the receiver operating characteristic curve (ROC), sensitivity-SE and specificity-SP of each PSA level were evaluated for PC. Preoperative serum PSA levels in patients with PC (median-35.82 ng/ml, min-6 ng/ml, max-960.40 ng/ml) were significantly higher than with PIN (median-9.15 ng/ml, min-3.16 ng/ml, max-27.61 ng/ml) and BPH (median-8.68 ng/ml, min-0.80 ng/ml, max-31.20 ng/ml). The best diagnostic characteristics of the PSA are on limit value 10 ng/ml (AUC=0.781, SE=92.9%; SP=63.3%; p<0,0001). PSA is of great help in diagnosis of advanced and initial form of PC. The chance of PC diagnosis was greater than that for other pathological changes when PSA level was higher than 10 ng/ml.

Prostate specific antigen (PSA) in diagnosis of polycystic ovarian syndrome – a new insight

Introduction: Polycystic ovary syndrome (PCOS) is the commonest endocrine disorder and cause of androgen excess in women. Prostate specific antigen (PSA) could be a new marker of hyperandrogenism in PCOS.Objective: The aim of the study was to assess the concentration PSA (total PSA - TPSA and free PSA - fPSA) in 165 patients with PCOS and 40 healthy female controls, the relationship between PSA (TPSA and fPSA) and hormonal parameters and to determine the performance of PSA in diagnosis of PCOS.Results: Total PSA was higher in PCOS group versus controls. The fPSA was below the lower detection levels among all patients. The median value of FAI was 4.31 in PCOS patients versus 1.79 in controls, p < 0.001. There was a correlation of TPSA and tT (r= 0.173, p = 0.027) and TPSA and FAI (r = 0.2603, p = 0.001). AUC for FAI was 82.1%, threshold 2.56 nmol/l, for tT AUC 80.5%, threshold 0.54 ng/ml, for TPSA AUC 66.3%, threshold 0.005 ng/ml. The ROC analysis for A AUC 62.7%, threshold 3.95 ng/ml.Conclusion: PCOS women have higher serum concentration of TPSA than controls. TPSA positively correlate with T and FAI, which is the best marker for hyperandrogenic states and has better accuracy for tT and total PSA serum levels in diagnostic of PCOS.

Usefulness of Total PSA Value in Prostate Diseases Diagnosis.

Introduction:Analysis of total value of prostate specific antigen (PSAT), with the unavoidable digital rectal examination (DRE) is the basis of prostate cancer detection.Aim:The aim of this study was to determine the specificity and sensitivity of the total value of PSAT in the diagnosis of prostate cancer. The aim was also to determine the significance of PSAT in diagnosis of benign prostate hyperplasia, precancerous conditions and inflammatory and atrophic changes of the prostate.Material and methods:Data were collected from the “Register of PH biopsy” of Clinic of Urology, CCU Sarajevo.Results:Analysis of correlation between the diagnosis and the PSAT value shows statistically significant negative correlation (r =-0,186; p = 0.006) in the sense that the value of the PSAT is highest in cancer patients, and the lowest in patients with benign prostatic hyperplasia. PSAT increases with age (r = 0.152; p = 0.025). For prostate cancer optimal sensitivity and specificity for PSAT value occurs at cut off value of> 8.6 ng /mL. Values lower than 2 ng/mL and higher than 10 ng/mL are most specific, and PPV increases with increasing value of PSAT. PSAT at values of <2 ng/mL and > 10 ng/mL are at high levels of specificity, and value > 10 ng / mL is also of high sensitivity in the detection of prostate cancer, and in this moment these values represent the optimal mode for the subsequent treatment.Conclusion:PSAT has a relative significance in the detection of prostate cancer, and should not be used as a guideline without DRE.

Efficacy of lower cut off value of serum prostate specific antigen in diagnosis of prostate cancer

Indications of prostate biopsy are high serum prostate specific antigen (PSA) value and or abnormal digital rectal examination (DRE) findings. Although serum PSA value of 4 ng/ml is the most commonly used threshold for recommending prostate biopsy, significant proportion of men harbor prostate cancer even when their serum PSA values are less than 4.0 ng/ml. Therefore present study was designed to determine the performance status of serum PSA in lower cut-off values. This hospital based prospective study was conducted in the Department of Urology of Bangabandhu Sheikh Mujib Medical University (BSMMU) and Comfort Nursing Home Pvt. Ltd, Dhaka from July 2009 to October 2010. Two hundred six male patients aged over 50 years having lower urinary tract symptoms (LUTS) and serum PSA more than 2.5 ng/ml were prepared for prostate biopsy. Trans rectal ultrasound (TRUS) guided biopsy was done. The test statistics used to analyze the data were descriptive statistics, sensitivity, specificity, positive and negative predictive value, ROC curve. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. In 2.5-4 serum PSA range, 28.26% (13 out of 46) of all malignancy were found, which would be missed if we take cut off value 4. At 2.5 PSA cut-off, Sensitivity 91.3%, Specificity 14.37%, PPV 23.46%, NPV 85.18%, Efficacy 31.55%. At 4 PSA cut-off value, Sensitivity 71.73%, Specificity 46.25%, PPV 27.73%, NPV 85.05%, Efficacy 51.94%. So it can be concluded that, for early diagnosis of prostate cancer cut-off value of serum PSA of 2.5 ng/ml can be recommended as an indication for prostate biopsy.

Role of Serum Total PSA (Prostate Specific Antigen) and Free to Total PSA Ratio in the Diagnosis of Carcinoma Prostate

The objective of the study was to evaluate and compare the role of total and free/total ratio of serum prostate specific antigen level in diagnosing carcinoma prostate. A cross sectional study was conducted at the Department of Biochemistry, Dhaka Medical College (DMC) with collaboration of the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka from July 2008 to June 2009. This study was carried out on 60 patients above 50 years of age who attended the Department of Urology, Dhaka Medical College Hospital, complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically benign prostatic hyperplasia (BPH) or cancer prostate. It was aimed to assess the role of total and free/total ratio of serum PSA in diagnosis of BPH and carcinoma prostate with reference to histological diagnosis. All the cases were evaluated by history, physical examination including digital rectal examination, serum prostate specific antigen level, transabdominal/ trans-rectal ultra- sonogram. From all patients, blood sample were collected before digital rectal examination or any per urethral manipulation. Final diagnosis was obtained by histo-pathological examination, specimen being obtained by perrectal biopsy with biopsy-gun. Histopathological examination detected prostate cancer in 20 out of 60 patient and 17 of these Cap 20 have a total PSA ? 4 ng/ml and only 3 have total PSA ? 4 ng/ml. 18 of these 20 have free to total ratio ?0.16 and 02 have f/t ratio ?0.16. Among 60 patients, 40 patients were detected BPH on histopathological diagnosis. 20 of these BPH patient have tPSA ? 4 ng/ml and 20 of BPH have tPSA ? 4 ng/ml. 38 of 40 BPH patient have f/t ratio &gt;0.16 and 2 of 40 patient are f/t ratio ?0.16. Receiver operating characteristic analysis indicated a threshold f/t ratio ? 0.16 was optimum discriminatory level. The sensitivity of total serum PSA (at cut off value of &gt;4 ng/ml) in correctly differentiating prostatic carcinoma of those who have the condition is 85%, while the specificity of the test in correctly detecting those who do not have the disease is 50%. The PPV is 45.9%, NPV is 87% and accuracy is 61.7%. The sensitivity of free/total serum PSA (at cut off value of 0.16 ng/ml) in correctly differentiating prostatic carcinoma from BPH is 90%, while the specificity of the test in correctly detecting those who do not have prostatic carcinoma is 95%. The PPV of the test is 90% and the NPV of the test is 95%. The overall accuracy of the test is 93.3%. This study showed significant difference of total and free/total ratio of serum prostate specific antigen (PSA) in differentiating benign prostatic hyperplasia (BPH) from carcinoma prostate. Receiver operating characteristic curves showed advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. From the study it may be concluded that total and f/t ratio of prostate specific antigen (PSA) is a useful marker in diagnosis of carcinoma prostate. Free/total ratio is more accurate than total PSA. DOI: http://dx.doi.org/10.3329/bjmb.v4i1.13778 Bangladesh J Med Biochem 2011; 4(1): 21-26

Transition zone PSA density improves the prostate cancer detection rate both in PSA 4.0–10.0 and 10.1–20.0 ng/ml in Chinese men

ObjectivesWe hypothesized the prostate-specific antigen (PSA) “grey zone” in Chinese men was higher than the traditional value (4.0–10.0 ng/ml) since incidence of prostate cancer (CaP) in Chinese men was relative low. We then assessed the efficiencies of transition zone PSA density (TZPSAD) in the diagnosis of CaP in Chinese men with a PSA of both 4.0–10.0 and 10.1–20.0 ng/ml. Materials and methodsMen had a prostatic biopsy for detecting CaP from November 1999 to August 2009 were retrospectively retrieved from our computer center. Those had a document of transrectal ultrasound transition zone measurement with a PSA of 4.0–20.0 ng/ml were included. Receiver-operating characteristic (ROC) curve was used to analyze the efficiencies of PSA and TZPSAD in the diagnosis of CaP. ResultsA total of 189 men were included in the study. Of these men, 78 and 111 had a PSA of 4.0–10.0 and 10.1–20.0 ng/ml, respectively. The rate of CaP in men with a PSA of 4.0–10.0 ng/ml was not statistically significantly different compared with those with a PSA of 10.1–20.0 ng/ml (20.5% vs. 21.6%, P = 0.854). The areas under the ROC curve (AUCs) in diagnosis of CaP for PSA and TZPSAD were 0.569 and 0.702 in men with a PSA of 4.0–10.0 ng/ml and 0.463 and 0.730 in men with a PSA of 10.1–20.0 ng/ml, respectively. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 4.0–10.0 ng/ml was 0.370 ng/ml/ml, the sensitivity of which equaled 68.8%, specificity 72.6%. The best cut-off of TZPSAD in predicting CaP in men with a PSA of 10.1–20.0 ng/ml was 0.500 ng/ml/ml. Its sensitivity equaled 70.8%, specificity 70.1%. ConclusionsUsing TZPSAD can improve the efficiency of PSA in diagnosis of CaP and decreases the unnecessary prostatic biopsy in men with a PSA of both 4.0–10.0 and 10.1–20.0 ng/ml in Chinese men.

The clinical value of prostate specific antigen for diagnosis of prostate cancer

Objective To research the relationship between free/total prostate specific antigen (f/t PSA), PSA density(PSAD) and prostate cancer(PCa), to explore healthy middle and old-aged,the patients with BPH, the scope of reference value of PSA,frce PSA(fPSA), f/t PSA and PSAD in patients serum with PCa. Methods To de-tect 307 cases of healthy gerontism male,236 of BHP and 41 of PSA and fPSA in patients with PCa,to calcuLate f/t PSA and PSAD, to investigate the dependability between PSA ,IPSA ,f/t PSA ,P SAD and healthy male, the patients ofBHP,the PCa ,to determine the scope of reference value PSA,fPSA,f/t PSA and PSAD fitting for Chinese. Results PSA and fPSA in patients with PCa are obviously higher than normal control(P <0.01). f/t PSA is obviously lower than the BPH and normal control(P < 0.01). When PSA is 9.25 and f/t PSA is 20%, there are better value of clini-cal diagnosis,when PSAD is 0.18 (AUC = 0.635), we can get best aceuration of diagnosis. Conclusions f/t PSA and PSAD are better than PSA in clinical diagnosis. When PSA is more than 9.25,f/t PSA is less than 20% or PSAD is more than 0.18 is significance for diagnosis. The normal reference value of PSA less than 9.25,f/t PSA more than 20%, PSAD less than 0.18 is fit for Chinese. Key words: Prostate,neoplasm; Prostate-specific antige

SERIAL PROSTATE SPECIFIC ANTIGEN, FREE-TO-TOTAL PROSTATE SPECIFIC ANTIGEN RATIO AND COMPLEXED PROSTATE SPECIFIC ANTIGEN FOR THE DIAGNOSIS OF PROSTATE CANCER

The free-to-total prostate specific antigen (PSA) ratio and complexed PSA have been introduced as adjuncts to total PSA for prostate cancer screening. Little data exist on the use of these tests for serial PSA screening. We compared serial total PSA, the free-to-total PSA ratio and calculated complexed PSA in men diagnosed with prostate cancer and matched controls in a population based study. We identified 90 men diagnosed with prostate cancer between 1988 and 1996 with at least 3 serial serum samples obtained at 2-year intervals who were participants in the beta-Carotene and Retinol Efficacy Trial for the prevention of lung cancer. Samples were available up to 10 years before diagnosis. A total of 90 age matched men from the same cohort without prostate carcinoma were identified as controls. Free and total PSA was measured by the Abbott AxSYM system. Baseline demographics of cases and controls were similar. At baseline and diagnosis the men with prostate cancer had higher total and complexed PSA, and a lower free-to-total PSA ratio than controls. Mean followup was 5.2 years in cases and 5.5 in controls. The yearly change in PSA parameters in cases versus controls was 20.7% versus 3.5% for total, -3.4% versus 0.2% for free-to-total and 21.5% versus 3.4% for complexed PSA (p <0.0001). At diagnosis PSA alone was estimated to perform with more than 90% specificity in our model. In this population based study total PSA was superior to the free-to-total PSA ratio for predicting the development of prostate cancer. While serial changes in free-to-total PSA ratios with time were statistically significantly different in men diagnosed with prostate cancer and controls, the magnitude of these serial changes were slight enough to render them clinically insignificant.

THE PERCENT OF CORES POSITIVE FOR CANCER IN PROSTATE NEEDLE BIOPSY SPECIMENS IS STRONGLY PREDICTIVE OF TUMOR STAGE AND VOLUME AT RADICAL PROSTATECTOMY

Pretreatment clinical staging of prostatic adenocarcinoma is important due to the increasing use of nonsurgical treatment options. Using multivariate analysis we assessed the predictive value of biopsy cores positive for cancer as a percent of all cores obtained as well as the percent surface area of needle cores involved with tumor for determining tumor volume and pathological stage at radical prostatectomy. Candidate variables for the multivariate model included patient age, clinical disease stage, serum prostate specific antigen (PSA) and Gleason score of cancer in the needle biopsy. We reviewed prostate needle biopsy findings in 207 consecutive patients who subsequently underwent radical retropubic prostatectomy. Each biopsy specimen was assessed for tumor involvement by calculating the percent of cores positive for cancer, percent surface area involved in all cores and Gleason score. Initial serum PSA and preoperative clinical disease stage were incorporated with biopsy results into a multivariate model to determine the parameters most predictive of pathological stage and tumor volume at radical retropubic prostatectomy. Of the 207 patients 152 (73.4%) had organ confined cancer and 55 (26.6%) had extraprostatic extension (pathological stages T2 and T3 or greater, respectively). Preoperative clinical staging information was available in 195 cases, in which disease was clinically confined and not confined in 184 (94.4%) and 11 (5.6%), respectively. Needle biopsy revealed a surface area of cancer ranging from less than 5% in 69 patients (33.3%) to 90% (mean 16, median 10). Univariate analysis demonstrated that the risk of extraprostatic extension was predicted by preoperative serum PSA (p = 0.027), the percent of cores and percent of surface area positive for cancer (p <0.0001), and Gleason score (p = 0.0009). Clinical stage approached significance (p = 0.071). Multivariate analysis showed that the percent of positive cores (p = 0.0003), initial serum PSA (p = 0.005) and Gleason score of cancer in the needle biopsy (p = 0.03) were the only parameters that jointly predicted pathological stage (T2 versus T3). Percent of tumor surface area involvement in the needle biopsies did not add any more information after the percent of positive cores was known. Univariate analysis revealed that the percent of cores positive for cancer (Spearman r = 0.52, p <0.0001), Gleason score (Spearman r = 0.34, p <0.0001) and initial serum PSA (Spearman r = 0.24, p = 0.003) were predictive of log tumor volume at radical prostatectomy, while clinical stage was not (rank sum test p = 0.14). On multivariate analysis the percent of positive cores (p <0.0001), Gleason score (p <0.0001) and initial serum PSA (0.0033) were the only variables that jointly were predictive of tumor volume. The percent of needle biopsy cores and surface area positive for cancer are the strongest predictors of pathological stage and tumor volume on multivariate analysis incorporating preoperative serum PSA and Gleason score.

The effects of ejaculation on serum prostate specific antigen.

We evaluated the correlation of prostate specific antigen (PSA) and ejaculation in patients with symptomatic benign prostatic hyperplasia and an active sexual life. In a study of 40 patients 50 to 60 years old (mean age 55) with prostatic symptoms serum PSA was evaluated before as well as 1 and 7 days after ejaculation. Due to clinical significance of PSA in diagnosis and monitoring of prostate cancer, we included men at risk age and with an active sex life. The results were compared to those of a control group of 10 asymptomatic (without coitus) men 50 to 60 years old (mean age 55 years). There were no statistically significant differences in PSA levels before and after ejaculation or between the groups. These results suggested that there was no physiological relationship between ejaculation and PSA level. Based on our data we conclude that sexual activity does not preclude the use of PSA to screen men for prostatic cancer.

The Effects of Ejaculation on Serum Prostate Specific Antigen

Purpose We evaluated the correlation of prostate specific antigen (PSA) and ejaculation in patients with symptomatic benign prostatic hyperplasia and an active sexual life. Materials and Methods In a study of 40 patients 50 to 60 years old (mean age 55) with prostatic symptoms serum PSA was evaluated before as well as 1 and 7 days after ejaculation. Due to the clinical significance of PSA in diagnosis and monitoring of prostate cancer, we included men at risk age and with an active sexual life. Results The results were compared to those of a control group of 10 asymptomatic (without coitus) men 50 to 60 years old (mean age 55 years). There were no statistically significant differences in PSA levels before and after ejaculation or between the groups. These results suggested that there was no physiological relationship between ejaculation and PSA level. Conclusions Based on our data we conclude that sexual activity does not preclude the use of PSA to screen men for prostatic cancer.

Prostate specific antigen in diagnosis, staging, and follow-up of prostate cancer.

Prostate specific antigen in diagnosis, staging, and follow-up of prostate cancer.

Free PSA is a Better Tumor Marker than Serum Total PSA in Diagnosis of Prostatic Carcinoma

Estimation of serum prostate specific antigen (PSA) has been considered as valuable non-invasive biochemical diagnostic tool for early detection of prostatic carcinoma. This cross sectional purposive study was carried out to compare the performance of serum total PSA and free PSA in terms of their sensitivity, specificity and overall diagnostic accuracy for prostatic carcinoma among clinically suspected cases. This study included a total of fifty (50) DRE (digital rectal examination) positive patients admitted in Rajshahi Medical College Hospital (RMCH) and Private hospitals in Rajshahi city during the period of January, 2006 to January, 2008. Estimation of serum total PSA and free PSA were done by ELISA (Enzyme linked immunosorbent assay) method using commercially available kits and histopathological examination of the surgically resected prostatic tissue was done for laboratory confirmation of the diagnosis of prostatic carcinoma for all patients. Diagnostic sensitivities, specificities and overall accuracy of serum total PSA and free PSA were calculated using standard formulae against histopathological diagnosis. Prostatic carcinoma was detected by histopathological examination in 41 cases out of 50 patients with the mean age of 71.2 ± 10.1 years. The sensitivity, specificity and overall diagnostic accuracy of serum total PSA (at cut off value of ≥10 ng/ml) were found to be 80.48%, 88.90% and 82.00% respectively while they were 92.68%, 77.80% and 90.00% respectively for serum percent free PSA (at cut off value of ≤25%). It is inferred that percent free PSA is a better tumor marker than serum total PSA in the diagnosis of prostate carcinoma. DOI: 10.3329/taj.v22i1.5017 TAJ 2009; 22(1): 30-35