Prostate-specific Antigen Levels In Men Research Articles

Effects of exercise during active surveillance for prostate cancer: A systematic review and meta-analysis.

The efficacy of exercise in men with prostate cancer (PCa) on active surveillance (AS) remains unclear. In this meta-analysis, we aimed to examine the effects of exercise in PCa patients on AS. A literature search was conducted in PubMed, EMBASE, and the Cochrane Library using search terms, including exercise, PCa, AS, and randomized controlled trials (RCTs). The means and standard deviations for peak oxygen consumption (VO2peak), prostate-specific antigen (PSA) levels, and quality of life (QoL) were extracted for the intervention and control groups. A random-effects model was used to summarize the effects of exercise. Of the 158 identified studies, six RCTs with 332 patients were included. The interventions included lifestyle modifications (aerobic exercise + diet) in three studies and different exercise modalities in three studies. The intervention duration was 2-12 months; three interventions were supervised and three were self-directed. The pooled weighted mean difference between exercise and usual care for VO2peak was 1.42 mL/kg/min (95% confidence interval [CI]: 0.30 to 2.54, P ≤ 0.001). A non-significant effect was observed for QoL (pooled standardized mean difference [SMD]: 0.24, 95% CI: - 0.03 to 0.51, P = 0.08) which became statistically significant and stronger after excluding one outlier study (P < 0.001). Exercise also had a positive effect on PSA levels (pooled SMD: - 0.43, 95% CI: - 0.87 to 0.01, P = 0.05). Exercise improves cardiorespiratory fitness and may improve QoL and PSA levels in men with PCa on AS. Further studies with larger sample sizes are warranted to obtain more reliable results.

Is the Serum Prostate-Specific Antigen Level Affected by Urethral Catheterization in Patients with Acute Urinary Retention?

Background: The reason for elevated serum prostate-specific antigen (PSA) levels in patients undergoing urethral catheterization due to acute urinary retention (AUR) remains a significant and controversial issue. Objectives: To assess the serum PSA level in men with AUR and its changes after catheterization. Methods: This prospective quasi-experimental study was conducted on 43 patients who underwent transurethral catheterization following AUR caused by benign prostatic hyperplasia (BPH). Total PSA levels and free/total PSA ratios were measured before catheterization and one and three days after catheter insertion. Additionally, prostate volume and urine output after catheterization (UOAC) were recorded. Results: The mean age, prostate volume, and UOAC of the patients were 69.05 ± 9.45 years, 60.51 ± 26.35 g, and 844.04 ± 341.66 mL, respectively. The mean and median baseline total PSA levels were 12.59 ± 17.71 ng/mL and 6.30 ng/mL, respectively. These values changed to 13.73 ± 19.83 ng/mL (median = 4.80 ng/mL) and 11.57 ± 17.70 ng/mL (median = 4.40 ng/mL) after 1 and 3 days of catheterization, respectively. The changes in total PSA and free/total PSA levels during the study period were not statistically significant (P &gt; 0.05). Moreover, the PSA levels showed no statistically significant difference before, 1 day, and 3 days after catheterization in groups with total PSA ≤ 4 and total PSA &gt; 4 (P = 0.37; 0.22, respectively). Conclusions: Our results suggest an initial elevation in PSA levels in patients with AUR before urethral catheterization. Both PSA and free/total PSA ratios showed no statistically significant differences before and after urethral catheter insertion, and initial PSA did not affect its changes after catheterization.

Saw Palmetto may fight prostate cancer.

Saw Palmetto may fight prostate cancer.

Association of Prostate-Specific Antigen Levels with Prostate Cancer Risk in a Multiethnic Population: Stability Over Time and Comparison with Polygenic Risk Score.

Studies in men of European ancestry suggest prostate-specific antigen (PSA) as a marker of early prostate cancer development that may help to risk-stratify men earlier in life. We examined PSA levels in men measured up to 10+ years before a prostate cancer diagnosis in association with prostate cancer risk in 2,245 cases and 2,203 controls of African American, Latino, Japanese, Native Hawaiian, and White men in the Multiethnic Cohort. We also compared the discriminative ability of PSA to polygenic risk score (PRS) for prostate cancer. Excluding cases diagnosed within 2 and 10 years of blood draw, men with PSA above the median had a prostate cancer OR (95% CIs) of 9.12 (7.66-10.92) and 3.52 (2.50-5.03), respectively, compared with men with PSA below the median. A PSA level above the median identified 90% and 75% of cases diagnosed more than 2 and 10 years after blood draw, respectively. The associations were significantly greater for Gleason ≤7 versus 8+ disease. At 10+ years, the association of prostate cancer with PSA was comparable with that with the PRS [OR per SD increase: 1.88 (1.45-2.46) and 2.12 (1.55-2.93), respectively]. We found PSA to be an informative marker of prostate cancer risk at least a decade before diagnosis across multiethnic populations. This association was diminished with increasing time, greater for low grade tumors, and comparable with a PRS when measured 10+ years before diagnosis. Our multiethnic investigation suggests broad clinical implications on the utility of PSA and PRS for risk stratification in prostate cancer screening practices.

Presence of Specific Periodontal Pathogens in Prostate Gland Diagnosed With Chronic Inflammation and Adenocarcinoma.

BackgroundIntraprostatic inflammation is frequently observed in the prostate and linked to prostatic diseases, including prostatitis, benign prostatic hyperplasia (BPH), and cancer. The etiology of prostate diseases is unclear. Periodontal diseases are associated with an increased risk of prostate diseases. In men, chronic prostatitis and moderate/severe periodontitis have significantly elevated serum prostate-specific antigen (PSA) levels. Treatment of periodontal disease reduced PSA levels in men. The presence of periodontal pathogens deoxyribonucleic acid (DNA) was identified in the prostate fluid of prostatitis patients. These pathogenic bacteria might have the potential to trigger prostatitis progressing to prostatic adenocarcinoma. The mechanism(s) explaining the etiology of association between periodontal disease and prostate cancer remains unclear. However, the presence of periodontal pathogens has not been analyzed in the prostate gland.ObjectiveTo identify and compare the presence of specific periodontal pathogens in the areas of BPH, inflammation, and cancer of the prostate glands diagnosed with malignancy.Materials and methodsWhole-mount radical prostatectomy sections from men (n=30) were identified for BPH, inflammation, and cancer areas and marked for tissue procurement. The tissues were subjected to DNA isolation and analysis of microbial DNA and total bacterial load for the following pathogens, including Porphyromonas gingivalis strain ATCC 33277, Prevotella intermedia strain B422, Treponema denticola strain 35405, Fusobacterium nucleatum subsp. fusiform strain, Tannerella forsythia strain ATCC 43037, and Campylobacter​​​​​​​ rectus strain ATCC 33238performed real-time PCR. The universal bacterial primer pairs were used to detect genomic DNA (gDNA) from the total bacteria present in the samples. All species-specific primers were designed to target the variable regions of the 16S ribosomal RNA (rRNA). Data were analyzed using the 2-ΔΔCT method, statistically validated using unpaired t-test and ANOVA test.ResultsA total of 90 samples of prostate tissue specimens were analyzed for periodontal pathogens; only one pathogen (F. nucleatum subsp. fusiform strain ATCC 51190) showed a significant difference compared to the expression of S. epidermidis (internal control). In particular, F. nucleatum expression was 9, 11.9, and 10.3-fold higher in BPH, inflammation, and cancer, respectively, at p-value <0.05. Moreover, the bacterial load abundance/expression was almost similar in BPH (46.8-fold), inflammation (40.9 fold), and cancer (41.5 fold) higher. There was no significant difference in bacterial load (folder change) among the three areas of BPH, inflammation, and cancer (p-valve>0.05). Similarly, there was no significant difference between F. nucleatum (folder change) among the three areas (p-valve>0.05).Conclusion Fusobacterium nucleatum is identified in the prostates that harbor cancer, chronic inflammation, and BPH.

Efficacy and safety of onabotulinumtoxinA in patients with overactive bladder: subgroup analyses by sex and by serum prostate-specific antigen levels in men from a randomized controlled trial

PurposeWe aimed to assess onabotulinumtoxinA treatment outcomes by sex in patients with overactive bladder (OAB) and then explore the impact of serum prostate-specific antigen (PSA) levels in men.MethodsPatients inadequately managed with OAB medications were randomized to receive single-dose onabotulinumtoxinA (100 U) or placebo intravesical injection in a phase III trial in Japan. We performed subgroup analyses by sex and post-hoc subgroup analyses using male PSA categories.ResultsIn women (n = 186), onabotulinumtoxinA demonstrated statistically significant and clinically relevant improvements in all urinary symptoms at Week 12. In men with lower PSA (< 1.5 ng/mL, n = 40), onabotulinumtoxinA also showed numerically greater reductions in urinary symptom frequency than placebo; the between-group differences (onabotulinumtoxinA minus placebo) in change from baseline in the average daily number at Week 12 for urinary incontinence (UI), urgency UI, micturition, urgency, and nocturia were − 1.43, − 1.79, − 2.81, − 2.45, and − 0.32 episodes, respectively. In men with higher PSA (≥ 1.5 ng/mL, n = 22), onabotulinumtoxinA did not reduce urinary symptom frequency. Some patients treated with onabotulinumtoxinA showed elevated post-void residual urine volume at Week 2 (≥ 200 mL): 4 of 91 women, none of the men with lower PSA and 3 of 11 men with higher PSA.ConclusionsOnabotulinumtoxinA was efficacious and well tolerated in women and in men with lower PSA levels. Given our post-hoc subgroup analyses which suggested that onabotulinumtoxinA treatment is a good treatment option for OAB males with lower PSA levels, future studies having prostate volume data with larger sample size are warranted to verify our findings.ClinicalTrials.gov IdentifierNCT02820844 (first posted July 1, 2016). https://clinicaltrials.gov/ct2/show/NCT02820844.

Clinical factors affecting prostate-specific antigen levels in prostate cancer patients undergoing radical prostatectomy: a retrospective study.

Background:Since prostate-specific antigen (PSA) levels can be influenced by some routinely available clinical factors, a retrospective study was conducted to explore the influence of obesity, smoking habit, heavy drinking and chronic obstructive pulmonary disease on PSA levels in men with histologically confirmed prostate cancer.Patients & methods:We reviewed the medical records of 833 prostate cancer patients undergoing radical prostatectomy.Results:Serum PSA levels at the time of surgery were not associated with either BMI or history of chronic obstructive pulmonary disease or heavy drinking. Conversely, PSA levels were associated with smoking status.Conclusion:Among the clinical factors explored in this homogeneous population, only tobacco use was associated with PSA levels, which should be considered when using PSA-based screening in male smokers.

Role of serum androgens and prostate-specific antigen levels in men with androgenetic alopecia

Background Androgenetic alopecia (AGA) is the most common form of hair loss. It is caused by continuous miniaturization of affected hair follicles. Genetic factors and androgenic factors especially dihydrotestosterone (DHT), which is a testosterone tissue metabolite, play major roles in the pathogenesis of AGA. Many studies suggest that AGA may be a marker of increased risk of prostate cancer. Objective The aim of the study was to determine the role of serum androgens and prostate-specific antigen (PSA) in men with AGA. Patients and methods The study included 80 participants: 40 men were diagnosed with AGA and 40 age-matched healthy male volunteers served as a control group. The authors also divided patient groups into two subgroups: frontal AGA group and vertical AGA group. All participants were subjected to measurement of serum level of T, DHT, and PSA by enzyme-linked immunosorbent assay. Results This study showed that mean serum level of testosterone and DHT in patients with AGA was higher than that in the control group and mean serum level of testosterone in the vertical AGA group was higher than that in the frontal AGA group. There was no significant difference between patients and controls regarding mean serum level of PSA. Conclusion This study showed that serum androgens play an important role in the development of AGA and there is a strong association between serum level of androgens and staging of AGA, whether frontal or vertical.

Low endogenous testosterone level is associated with high-risk prostate-specific antigen level in men with prostate cancer disease

Background: Low serum testosterone levels is hypothesized to predict adverse outcomes in prostate cancer patients. This study was structured to investigate this hypothesis using high-risk serum prostate-specific antigen as a marker of adverse outcome of the disease.Methods: This was a retrospective analysis of serum total testosterone (TT) and total prostate-specific antigen (PSA) records of prostate cancer patients in a tertiary hospital in Nigeria. Records of age, serum TT, and serum PSA test results from 1st January 2008 to 31st December 2017 were acquired from laboratory and medical records and analyzed with SPSS software version 20. Results: The records of 450 men with prostate cancer were recruited for the study. The majority (56.7%) of the study cohorts were between 70 to 79 years of age. Hypogonadism was observed in 34.7% of the study cohort. The hypogonadal patients had higher PSA values compared to the eugonadal patients (p&lt;0.001). Lower testosterone values were observed in patients with high-risk PSA levels (p&lt;0.001). Strong significant negative correlations were observed between total PSA and endogenous testosterone within the overall study cohort (r= -0.792; p&lt; 0.001), the hypogonadal group (r= -0.615; p &lt; 0.001), and among the high-risk PSA group (r= -0.632; p&lt; 0.001). Conclusions: The findings of this study suggest low, rather than high, endogenous testosterone in prostate cancer disease is associated with high-risk PSA levels which implies adverse outcome in prostate cancer patients. However, further studies are warranted to confirm this association.

Early dutasteride monotherapy in men with detectable serum prostate-specific antigen levels following radical prostatectomy: A prospective trial

PurposeTo investigate the effects of early administration of dutasteride in patients with detectable serum prostate-specific antigen (PSA) levels after radical prostatectomy (RP).Materials and MethodsA prospective open-label study, with a cumulative analysis of asymptomatic increase in PSA following RP, was conducted from January 2005 to December 2013. An early increase in PSA level was defined as detectable serum PSA level> 0.04 ng/mL. Patients with PSA level>0.04 ng/mL were treated with dutasteride 0.5 mg daily. Serum PSA level and biochemical recurrence (BCR) were monitored. We divided the patients into 2 groups based on the serum PSA response after dutasteride treatment.ResultsEighty patients were included in the study. At the median follow-up of 51.8 months, 56 patients (70.0%) showed a decrease of greater than 10% in serum PSA level, and 24 showed increased PSA levels. Twelve of the 56 patients with PSA response showed subsequently increased PSA. Intergroup differences in preoperative PSA levels, PSA nadir levels, and Gleason score of 6 or less were significant (p=0.028, p=0.030, and p=0.035, respectively). A multivariate analysis revealed that Gleason score of 6 or less (p=0.018) and PSA nadir levels (p=0.011) were predictive factors for PSA response after early dutasteride treatment in men with increased PSA levels following RP.ConclusionsEarly monotherapy of dutasteride showed a decline in serum PSA levels in men with lower nadir PSA levels, and a Gleason score 6, when the serum PSA was detected after RP.

Prostate Specific Antigen Screening among Men in Abakaliki, South East Nigeria

Background: Prostate cancer is the most common type of cancer among Nigerian men. Prostate specific antigen (PSA) is produced by the prostate gland and it is an important tumor marker in the screening and diagnosis of prostate cancer because the latter is often associated with elevated PSA levels. The aim of this study was to evaluate the profile and PSA levels of men presenting for prostate cancer screening at the National Obstetric Fistula Centre, Abakaliki, Nigeria. Methods: This was a retrospective study of 103 patients who were seen between January 2014 and December 2015 and screened for prostate cancer using PSA assay. Data was extracted from folders of patients using a proforma and analysed using the Statistical Package for Social Sciences (SPSS), version 21. Result: Out of the 103 clients studied, 67 (65%) were between the ages of 40 and 59 years. The mean age was 54.38 ± 12.5 years. Eighty-one (78.6%) of the study population had PSA levels 4 ng/ml and below, 5 (4.9%) had PSA levels of 4.1 - 10 ng/ml, while 17 (16.5%) had PSA levels > 10 ng/ml. The mean PSA was 4.75 ± 8.2 ng/ml. None of the patients with family history of cancer had PSA levels of >4 ng/ml. Those who were positive for HIV also had normal PSA results. Conclusion: The findings from this study showed that the prevalence of men with raised PSA (>4 ng/ml) was high (21.4%) especially in the 60 - 69 years age group. There is need to increase prostate cancer screening using PSA in our setting. The use of other parameters such as digital rectal examination, PSA density, PSA velocity and free PSA will be helpful to determine the need for histological diagnosis in these patients.

Variation in serum prostate-specific antigen levels in men with prostate cancer managed with active surveillance.

To describe fluctuations in prostate-specific antigen (PSA) levels in men managed with active surveillance (AS) to determine if a single PSA increase is a consistent measure to use to trigger intervention. We evaluated data on 541 patients undergoing AS between 1995 and 2011. PSA variation was described by studying the Kaplan-Meier probability of patients' PSA levels reaching 4 or 7 ng/mL, falling below those thresholds, and then rising to those thresholds again. We also examined PSA variation by calculating the Kaplan-Meier probability of a PSA change followed by an equal or greater change in the opposite direction. We analysed data on 541 patients undergoing AS with a median (interquartile range [IQR]) of 8 (6-12) PSA measurements and undergoing AS for a median (IQR) of 4 (2-6) years. The 5-year estimate of the probability of reaching a threshold PSA of 7 ng/mL was 40% (95% confidence interval [CI] 35-46%) and the 5-year estimate of subsequently falling below this threshold was 90% (95% CI 82-95%). The 5-year estimate of a PSA direction change was 95% (95% CI 93-97%) overall and 56% (95% CI 51-61%) for PSA direction changes of ≥1 ng/mL. We observed a high probability of variability in PSA levels for patients on AS. The probability of changes in PSA, defined by an increase to the specified thresholds or a rise >1 ng/mL within 6 months and subsequent decrease of equal or greater value on a subsequent measurement, increases over time; therefore, a single change in PSA level is not a reliable endpoint for patients on AS.

Serum prostate-specific antigen levels in men with prediabetes: A cross-sectional study

Background. Previous studies demonstrated that men with type 2 diabetes mellitus (T2DM) had significantly lower serum prostate-specific antigen (PSA) levels than healthy men. However, the influence of prediabetes (preDM) on serum PSA levels is unknown. The aim of this study was to investigate the relationships between preDM and serum PSA levels. Methods. A cross-sectional analysis was conducted to determine the relationships between preDM and serum PSA levels. Data were obtained from men over 50 years of age who measured serum PSA levels in the physical examination center of Tianjin Union Medical Center from May to July 2014. Pearson's correlation analysis and multivariable linear regression analysis were utilized to calculate the correlations between PSA levels and various clinical and biochemical variables. Results. In age-matched analysis, the mean PSA values were significantly higher in the preDM group compared with the normoglycemia (NG) and T2DM groups (1.429 ng/mL vs. 1.086 ng/mL and 1.071 ng/mL; p < 0.05). In addition, multivariable linear regression analysis demonstrated that PSA was positively correlated with age, total cholesterol (TC) and preDM (p < 0.05). Negative correlation existed between PSA and T2DM (p < 0.05). Men with preDM had PSA values 31.6% higher than men without the condition (p < 0.05), whereas PSA levels were 17.5% lower in men with T2DM than in those without the condition (p < 0.05). Conclusions. Our results suggest preDM was an independent determinant of high PSA levels and support that men with T2DM had decreased PSA levels. Further larger studies are needed.

The effect of testosterone replacement therapy on prostate-specific antigen (PSA) levels in men being treated for hypogonadism: a systematic review and meta-analysis.

Testosterone replacement therapy is used for the treatment of age-related male hypogonadism, and prostate-specific antigen (PSA) is a primary screening tool for prostate cancer. The systematic review and meta-analysis aimed to determine the effect of testosterone replacement therapy on PSA levels.Medline, Cochrane Library, EMBASE, and Google Scholar databases were searched until February 28, 2014, and inclusion criteria were as follows: randomized controlled trial; intervention group received testosterone/androgen replacement therapy; control group did not receive treatment; and no history of prostate cancer. The primary outcome was change of PSA level between before and after treatment. Secondary outcomes were elevated PSA level after treatment, and the number of patients who developed prostate cancer.After initially identifying 511 articles, 15 studies with a total of 739 patients that received testosterone replacement and 385 controls were included. The duration of treatment ranged from 3 to 12 months. Patients treated with testosterone tended to have higher PSA levels, and thus a greater change than those that received control treatments (difference in means of PSA levels = 0.154, 95% confidence interval [CI] 0.069 to 0.238, P < 0.001). The difference in means of PSA levels were significant higher for patients that received testosterone intramuscularly (IM) than controls (difference in means of PSA levels = 0.271, 95% CI 0.117-0.425, P = 0.001). Elevated PSA levels after treatment were similar between patients that received treatment and controls (odds ratio [OR] = 1.02, 95% CI 0.48-2.20, P = 0.953). Only 3 studies provided data with respect to the development of prostate cancer, and rates were similar between those that received treatment and controls.Testosterone replacement therapy does not increase PSA levels in men being treated for hypogonadism, except when it is given IM and even the increase with IM administration is minimal.

PO360 IS PROSTATIC SERUM ANTIGEN CORRELATED WITH INSULIN RESISTANCE IN MEN WITH TYPE 2 DIABETES MELLITUS-METS

Background: Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that includes hypertension, diabetes mellitus, obesity, hypertriglyceridemia, and low high-density lipoprotein cholesterol, with insulin resistance as the underlying hallmark feature. The prevalence of MetS has been increasing worldwide and has become a major public health problem in many western countries. Recently, increasing evidences suggests that MetS may be involved in the development and progression of certain types of cancer as an independent etiologic factor including breast cancer, endometrial cancer, colorectal cancer, pancreatic cancer and prostate cancer. MetS was firstly observed as a composite factor associated with prostate cancer risk in 2004, and more studies have since reported the association between MetS and prostate cancer. In biologic models proposed to explain this association, researchers note the higher concentrations of insulin and insulin-like growth factor 1 (IGF-1) in early diabetes and the lower testosterone and IGF-1 levels and higher estrogen concentrations in long-term diabetes, Whether diabetes influences levels of biomarkers such as Prostate-Specific Antigen (PSA), which is involved in the detection of prostate cancer, is still unknown. Factors influencing serum PSA levels in men include age, benign prostatic hyperplasia, prostatitis, and Body Mass Index (BMI). In this study, we examined whether PSA on the person who have insulin resistance which is often happen in men with Type 2 Diabetes Mellitus- Metabolic Syndrome. Method: This cross sectional study was performed in Surabaya private clinic. Study period was six months between January to June 2014. Plasma concentrations of glycated haemoglobin (HbA1c) and fasting and post-prandial glucose were analysed and homeostatic model assessment of insulin resistance (HOMA-IR) were calculated. HOMA-IR value more than 2.0 is considered to be positive for IR. Statistical analysis was performed using SPSS 17.0 and Spearmen’s test. Result: Fifty two male subjects were enrolled in this study. The mean age was 62.32±8.72 years old, fasting blood sugar 139.68±43.65mg/dL, mean A1C 7.89±1.80%, the mean HOMA-IR 7.14±4.77, and the mean of PSA value was 3.76±1.99 ng/dL. The PSA showed negative correlation with Insulin Resistance (r = −0.049; p < 0.005). Conclusion: The level of PSA had negative correlation with insulin resistance among men with T2DM-MetS in this study.

Semen quality in middle-aged males: associations with prostate-specific antigen and age-related prostate conditions

Objective: To compare markers of semen quality and related reproductive indicators in middle-aged males in relation to serum prostate-specific antigen (PSA) levels. Methods: A total of 384 voluntary middle-aged men who underwent screening for prostate health were recruited. Reproductive function, semen quality, hormonal parameters, prostate-related pathologies, and PSA levels were measured. Results: Total sperm count and sperm concentration were decreased in men with elevated serum PSA compared with age-matched controls. Serum FSH levels differed significantly in subjects with non-malignant, pre-malignant, and malignant prostate conditions. PSA levels in men with three normal semen variables (semen volume ≥ 1.5 mL, sperm density ≥ 15 × 106/mL, and A + B motility ≥ 40%) were significantly lower compared with subjects with altered parameters (1.51 ng/ml vs. 2.47 ng/ml, respectively, p = 0.002). PSA showed a negative correlation with semen volume and total sperm count, and a positive correlation with semen interleukin-6. Conclusions: Our data demonstrate that serum PSA levels are related to impaired reproductive parameters in middle-aged subjects. While there is no consensus about the potential link between male factor infertility, impaired reproductive indicators, and prostate pathologies, this topic needs additional research focusing on the interactions between male aging, reproductive function, and the prostate.

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

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

Influence of Opioid Consumption on Serum Prostate-specific Antigen Levels in Men Without Clinical Evidence of Prostate Cancer

To determine the effect of opioid consumption on the serum prostate-specific antigen (PSA) level. From April 2009 to December 2011, 56 opioid users and 82 age-matched controls participated in the present study. The exclusion criteria were prostate cancer or other malignancies, serum PSA level ≥ 4 ng/dL, abnormal digital rectal examination findings, previous prostate surgery, pelvic radiotherapy, bladder stone, urinary tract infection, recent prostatic manipulation, and a history of taking drugs that alter the serum PSA level. The prostate volume and PSA, serum testosterone, and luteinizing and follicle-stimulating hormone levels were measured in the eligible participants and compared between the opioid users and control subjects. The study was conducted in accordance with the Declaration of Helsinki, and the institutional review board approved the study. The serum PSA level was significantly lower in opioid users compared with that in the control subjects (0.82 ± 0.77 vs 1.95 ± 1.00, P < .001). The testosterone level was also lower in the opioid users (339.08 ± 142.49 vs 396.71 ± 133.64, P = .008). The difference between the PSA levels remained significant when a comparison was performed between the eugonadal opioid users and eugonadal control subjects. Moreover, the effect of opioid consumption on the PSA level persisted on multivariate analysis, controlling for serum testosterone level. Opium consumption was associated with significant decline in the serum PSA level and warrants adjustment in the PSA cutpoints at which biopsy is recommended. Opioid-induced hypogonadism does not seem to account for the PSA decline, and additional studies are required to determine the involved mechanisms.

Effect of constipation on serum total prostate‐specific antigen levels in men

Many factors affecting serum prostate-specific antigen (PSA) levels have been described. The aim of this study was to examine the effect of constipation on serum PSA levels in men. Serum total PSA values were measured in 136 constipated patients before and after treatment for constipation. Moreover, they were compared with 45 control patients. Serum total PSA values in the constipated patients before treatment were significantly higher than those in the control group (2.29 ± 1.29 ng/mL vs 1.28 ± 0.86 ng/mL, P < 0.0001). After the treatment of constipation, serum total PSA values in the constipated patients were still higher than those in the control group, but this difference was not statistically significant (P = 0.0871). After the treatment of constipation, prostate biopsy rates were 6.6% and 2.2% in the study and control group, respectively (P = 0.2769). No prostate cancer was found in both groups. Constipation increases serum PSA levels in men. The presence of constipation must be considered in patients whose PSA is examined, especially in those with PSA levels that are borderline high or in the range of 2-10 ng/mL. Constipated patients must be first treated and then re-evaluated.

The illusion of prostate‐specific antigen decline in patients with metabolic syndrome and insulin resistance

What's known on the subject? and What does the study add? Studies have shown that PSA is negatively associated with obesity as a result of hemodilution or metabolic effect. Hemodilution could be the main reason for low PSA levels in obese men. However, the intrinsic metabolic effects such as insulin resistance (IR) or metabolic syndrome (MS) on PSA level have not been clearly evaluated although obesity is closely tied to MS and IR. We regarded MS and IR as the pathophysiological cornerstone of metabolic disorder in obesity and analyzed the relationships among MS, IR, and PSA levels, and plasma volume by using the concept of PSA mass, the total circulating PSA protein. PSA mass did not change depending on the severity of the obesity, MS or IR. Even the group with both MS and IR, which could be the most metabolically disturbed in this study, did not have different PSA mass, comparing with the group without any MS or IR. Thus, the decline in PSA level in men with MS or IR can be also explained by increased plasma volume other than any intrinsic metabolic effects. • To investigate the detailed mechanism of prostate-specific antigen (PSA) decline in metabolic syndrome (MS) and insulin resistance (IR), which lowers the predictive value of the PSA test, we examined the effect of haemodilution and the possibility of an intrinsic metabolic effect. • We analysed 28,315 men who underwent routine check-ups. We compared the age-adjusted mean PSA levels in subjects with and without MS before and after adjusting or stratifying the plasma volume. We analysed changes in PSA level, plasma volume and PSA mass according to obesity grade, number of MS components, IR severity and diagnosis of MS, IR or both using an analysis of covariance. • The PSA levels were lower in the group with MS than in the group without MS (P= 0.001), but this difference disappeared after adjusting or stratifying the plasma volume (P > 0.05 for all). The PSA levels decreased, plasma volume increased, and PSA mass did not change as the number of MS components increased (P= 0.002, P < 0.001, P= 0.55, respectively) or the IR severity increased (P= 0.001, P < 0.001, P= 0.34, respectively). • Similarly, PSA levels were lower, plasma volumes were higher and PSA masses were the same in subjects with MS (P= 0.002, P < 0.001, P= 0.10, respectively), IR (P= 0.018, P < 0.001, P= 0.94, respectively), or both (P= 0.003, P < 0.001, P= 0.86, respectively) than in subjects without those conditions. • The PSA decline in MS and IR may result simply from a haemodilution effect and be unrelated to intrinsic metabolic disturbances. For this reason, PSA levels could be underestimated in patients with MS or IR because of haemodilution.