Role Of Prostate-specific Antigen Research Articles

The role of prostate-specific antigen in the osteoblastic bone metastasis of prostate cancer: a literature review.

Prostate cancer is the only human malignancy that generates predominantly osteoblastic bone metastases, and osteoblastic bone metastases account for more than 90% of osseous metastases of prostate cancer. Prostate-specific antigen (PSA) plays an important role in the osteoblastic bone metastasis of prostate cancer, which can promote osteomimicry of prostate cancer cells, suppress osteoclast differentiation, and facilitate osteoblast proliferation and activation at metastatic sites. In the meantime, it can activate osteogenic factors, including insulin-like growth factor, transforming growth factor β2 and urokinase-type plasminogen activator, and meanwhile suppress osteolytic factors such as parathyroid hormone-related protein. To recapitulate, PSA plays a significant role in the osteoblastic predominance of prostate cancer bone metastasis and bone remodeling by regulating multiple cells and factors involved in osseous metastasis.

Prostate Specific Antigen as a Tumor Marker in Prostate Cancer: Exploring Biochemical and Clinical Aspects

This study explores the role of Prostate Specific Antigen (PSA) as a tumour marker in prostate cancer diagnosis and prognosis.A cohort of 120 participants aged 45 to 70 years underwent a cross-sectional analysis of PSA levels and their correlation with tumour characteristics.Data collection involved structured interviews and medical record reviews. Diagnostic assessments, including histopathological analysis and Gleason scores (6 to 9), were performed. PSA levels were correlated with tumour characteristics. Statistical analysis utilized IBM SPSS Statistics.The distribution of PSA levels (mean: 8.52 ng/mL, median: 7.89 ng/mL) reflected variations. A positive correlation (0.67) existed between PSA levels and Gleason scores. Receiver Operating Characteristic analysis yielded an AUC of 0.82, indicating good diagnostic accuracy.The study provides insights into PSA's diagnostic potential and its correlation with tumour characteristics in prostate cancer.Acknowledging limitations, this research prompts validation efforts to bridge research and clinical understanding.

Biomarkers of Aggressive Prostate Cancer at Diagnosis.

In the United States, prostate cancer (CaP) remains the second leading cause of cancer deaths in men. CaP is predominantly indolent at diagnosis, with a small fraction (25-30%) representing an aggressive subtype (Gleason score 7-10) that is prone to metastatic progression. This fact, coupled with the criticism surrounding the role of prostate specific antigen in prostate cancer screening, demonstrates the current need for a biomarker(s) that can identify clinically significant CaP and avoid unnecessary biopsy procedures and psychological implications of being diagnosed with low-risk prostate cancer. Although several diagnostic biomarkers are available to clinicians, very few comparative trials have been performed to assess the clinical effectiveness of these biomarkers. It is of note, however, that a majority of these clinical trials have been over-represented by men of Caucasian origin, despite the fact that African American men have a 1.7 times higher incidence and 2.1 times higher rate of mortality from prostate cancer. Biomarkers for CaP diagnosis based on the tissue of origin include urine-based gene expression assays (PCA3, Select MDx, ExoDx Prostate IntelliScore, Mi-Prostate Score, PCA3-PCGEM1 gene panel), blood-based protein biomarkers (4K, PHI), and tissue-based DNA biomarker (Confirm MDx). Another potential direction that has emerged to aid in the CaP diagnosis include multi-parametric magnetic resonance imaging (mpMRI) and bi-parametric magnetic resonance imaging (bpMRI), which in conjunction with clinically validated biomarkers may provide a better approach to predict clinically significant CaP at diagnosis. In this review, we discuss some of the adjunctive biomarker tests along with newer imaging modalities that are currently available to help clinicians decide which patients are at risk of having high-grade CaP on prostate biopsy with the emphasis on clinical utility of the tests across African American (AA) and Caucasian (CA) men.

The role of prostate-specific antigen and multiparametric magnetic resonance imaging in the diagnosis of granulomatous prostatitis induced by intravesical Bacillus Calmette-Guérin vaccine therapy in patients with nonmuscle invasive bladder cancer.

This study aimed to evaluate the role of serum prostate-specific antigen (PSA) levels and multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of granulomatous prostatitis (GP) induced by intravesical Bacillus Calmette-Guérin vaccine (BCG) therapy in patients with nonmuscle invasive bladder cancer (NMIBC). We retrospectively analyzed eight patients with bladder cancer who underwent intravesical BCG therapy after transurethral resection of bladder tumor (TURBt) cancer. All these eight patients received 12-core transrectal ultrasound-guided prostate systemic biopsies. Clinical data on PSA with T1-weighted imaging (T1WI), T2WI, diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) on mpMRI were enrolled in the study. H and E and acid-fast staining was performed to pathologically prove GP. Four of all eight cases were above 4 ng/ml total PSA (tPSA) levels and four cases were within normal ranges, while free PSA/tPSA levels decreased to lower than 16% in all patients. Every patient had hard prostatic nodules through digital rectal examination (DRE). All characters of prostate mpMRI did not show signal intensity (SI) of prostate cancer before BCG therapy but showed abnormal signals after BCG therapy. All nodular lesions showed equal SI on T1WI, lower SI on T2WI, higher SI on DWI, and lower SI on ADC after BCG therapy. Pathologic results were GP and acid-fast staining outcomes were positive in all biopsies. Perioperative serum PSA levels, prostate magnetic resonance imaging, and DRE may help in the diagnosis of GP induced by intravesical BCG therapy. In general, male patients with middle- and high-risk NMIBC are recommended to undertake DRE, PSA, and prostate mpMRI, if possible, before and after TURBt."

Aktif İzlem İçin Uygun Olan ve Radikal Prostatektomi ile Tedavi Edilen Prostat Kanserli Hastalarda Patolojik Yükselmeyi Gösteren Prediktif Faktörler

Objective: To evaluate the factors to predict Gleason score upgrading in prostate cancer patients who are suitable for active surveillance (AS) and the role of prostate-specific antigen (PSA) density in the management of these patients. Material and Methods: Seventy seven prostate cancer patients who had active surveillance criteria but preferred radical prostatectomy as the treatment instead of active surveillance protocol were included in the study. In our study, Gleason 3+3≤6 adenocarcinoma, positivity in maximum 2 biopsy cores in ≥12 core transrectal ultrasound guided systematic biopsy, PSA<10 ng/mL, and Clinical T Stage ≤2a were used as active follow-up criteria. Tumor grade in the radical prostate and prostate biopsy specimens were compared. Predictive factors of pathological upgrading after radical prostatectomy have been investigated. Results: There is statistically significant correlation between PSA density (p=0.042), prostate volume (p=0.010), maximum tumor length in a core (p=0.001), maximum percentage of tumor in a core (p=0.002), bladder neck involvement (p=0.023) and postoperative Gleason score upgrading in univariate analysis. The optimal cut-off values of PSA density and prostate volume were 0.12 ng/mL2 and 48 cc, respectively. There isn't statistically significant correlation between PSA, free PSA, free/total PSA, the length of biopsy core, perineural invasion, apical involment and postoperative Gleason score upgrading in univariate analysis. Maximum tumor length in a core and prostate volume were independent predictors of pathological Gleason score upgrading on multivariate regression. Conclusion: Prostate volume and maximum tumor length in a core are independent predictors of pathological Gleason score upgrading in our study. These factors should also be included in current AS criterias in addition to PSA density and tumor percentage.

The role of prostate-specific antigen in light of new scientific evidence: An update in 2020

ObjectiveTo review and update the latest scientific evidence gathered in recent years regarding prostate-specific antigen (PSA) for better implementation into routine clinical practice. Evidence acquisitionAnalysis of the available evidence on the current role of PSA, based on the experience of an expert panel in the subject under analysis. Evidence synthesisCurrently, PSA cannot be considered only as a guide for the presence or absence of prostate cancer. This determination can also help the urologist to decide on the most convenient treatment for a patient with benign prostatic hypertrophy (BPH) as a criterion for disease progression, and it can also suggest the suspicious existence of a prostatic tumor when there is PSA rise of >0.3 ng/ml over the level reached 6 months after having initiated treatment with 5-alpha-reductase inhibitor. However, the limits of this PSA rise with derivatives of alternative 5-alpha-reductase (5-ARI) inhibitors to dutasteride are controversial. Moreover, PSA is a key factor for the follow-up of patients with prostate adenocarcinoma at any stage who have received treatment (surgery, radiotherapy or focal therapies, hormone therapy), it acts as a guide to identify biochemical recurrence, to suspect the existence of local or distant recurrence, as well as to propose or discard adjuvant treatments. Finally, the role of PSA as a screening tool has been recently reinforced, demonstrating increased mortality rates or the existence of more aggressive cases of prostate cancer in those countries where the use of this tool has declined. ConclusionsWe present new data about the current role of PSA in the management of patients treated for BPH and/or prostate cancer that should be implemented into routine clinical practice, with special emphasis on the relevant role of this biomarker in the screening and follow-up of prostate cancer, as well as in the progression of BPH in dutasteride treatment.

Estimation of prostate specific antigen in metabolic syndrome- a study in south Indian male population

Introduction: The main aim of our study was to assess the role of prostate specific antigen in Indian males and to determine its correlation with insulin resistance in metabolic syndrome. Materials and Methods: For this study, 62 male subjects of 40-65 years having metabolic syndrome were selected. Body mass index, fasting blood sugar, serum prostate specific antigen, serum fasting insulin and insulin resistance were analyzed using multivariate regression analysis and Annova test. Results and Conclusion: There was no statistically significant difference between body mass index and prostate specific antigen, body mass index and insulin resistance, prostate specific antigen and triglyceride, prostate specific antigen and high density lipoprotein, and prostate specific antigen and fasting blood sugar. Keywords: Body mass index, Insulin resistance and Obesity, Prostate specific antigen.

Prostate-specific antigen modulates the osteogenic differentiation of MSCs via the cadherin 11-Akt axis.

BackgroundA high prevalence of osteoblastic bone metastases is characteristic of prostate cancer. Prostate‐specific antigen (PSA) is a serine protease uniquely produced by prostate cancer cells and is an important serological marker for prostate cancer. However, whether PSA modulates the osteogenic process remains largely unknown. In this study, we explored the effect of PSA on modulating the osteoblastic differentiation of mesenchymal stem cells (MSCs). In this study, we used flow cytometry, CCK‐8 assay, Alizarin red S (ARS) staining and quantification, alkaline phosphatase (ALP) activity and staining, Western blotting, and quantitative real‐time PCR (qRT‐PCR) to explore the effect of PSA on osteogenic differentiation of MSCs.ResultsWe first demonstrated that although PSA did not affect the proliferation, morphology, or phenotype of MSCs, it significantly promoted the osteogenic differentiation of MSCs in a concentration‐dependent manner. Furthermore, we demonstrated that PSA promoted the osteogenic differentiation of MSCs by elevating the expression of Cadherin 11 in MSCs and, thus, activating the Akt signaling pathway.ConclusionsIn conclusion, we demonstrated that PSA could promote the osteogenesis of MSCs through Akt signaling pathway activation by elevating the expression of cadherin‐11 in MSCs. These findings imply a possible role of PSA in osteoblastic bone metastases in prostate cancer.

Role of prostate specific antigen and prostate specific antigen density as biomarkers for medical and surgical treatment response in men with lower urinary tract symptoms

Prostate specific antigen and Prostate specific antigen-density are used for the initial evaluation of patient with LUTS due to benign prostatic enlargement in order to discriminate between benign conditions and prostate cancer. Conversely, the role of these markers during the follow up of benign prostatic enlargement patients is still unclear. The aim of our study is to evaluate the role of prostate specific antigen and prostate specific antigen density as outcome parameter for both medical and surgical treatment in patients with male LUTS. We performed a systematic review and meta-analysis based on data from clinical trials evaluating the clinical effect of medical or surgical therapy on LUTS/benign prostatic enlargement. Meta-regression analyses were done to evaluate the effects of several factors on IPSS score improvement. We selected 12 studies out of 433, including data on 1959 patients. Both medical and surgical treatment lead to a significant reduction of PSA levels as compared to baseline (P<0.001). However, after medical treatment, lower PSA values are associated with more significant improvements in lower urinary tract symptoms as measured with the IPSS, while after surgery (P<0.05), the recovery of urinary function does not correlate with the decline in PSA values (P=0.59). After medical treatment, the improvement in LUTS correlate with a decline of PSAD, while the opposite holds true in men treated with surgery (both: P<0.001). PSAD may represent an objective treatment outcome parameter and should be evaluated during the follow up of men treated for LUTS due to BPE as marker of treatment response.

Biomarkers for prostate cancer: prostate-specific antigen and beyond.

In recent years, several new biomarkers supplementing the role of prostate-specific antigen (PSA) have become available for men with prostate cancer. Although widely used in an ad hoc manner, the role of PSA in screening asymptomatic men for prostate cancer is controversial. Several expert panels, however, have recently recommended limited PSA screening following informed consent in average-risk men, aged 55-69 years. As a screening test for prostate cancer however, PSA has limited specificity and leads to overdiagnosis which in turn results in overtreatment. To increase specificity and reduce the number of unnecessary biopsies, biomarkers such as percent free PSA, prostate health index (PHI) or the 4K score may be used, while Progensa PCA3 may be measured to reduce the number of repeat biopsies in men with a previously negative biopsy. In addition to its role in screening, PSA is also widely used in the management of patients with diagnosed prostate cancer such as in surveillance following diagnosis, monitoring response to therapy and in combination with both clinical and histological criteria in risk stratification for recurrence. For determining aggressiveness and predicting outcome, especially in low- or intermediate-risk men, tissue-based multigene tests such as Decipher, Oncotype DX (Prostate), Prolaris and ProMark, may be used. Emerging therapy predictive biomarkers include AR-V7 for predicting lack of response to specific anti-androgens (enzalutamide, abiraterone), BRAC1/2 mutations for predicting benefit from PARP inhibitor and PORTOS for predicting benefit from radiotherapy. With the increased availability of multiple biomarkers, personalised treatment for men with prostate cancer is finally on the horizon.

Beyond the biomarker role: prostate-specific antigen (PSA) in the prostate cancer microenvironment.

The prostate-specific antigen (PSA) blood test is the accepted biomarker of tumor recurrence. PSA levels in serum correlate with disease progression, though its diagnostic accuracy is questionable. As a result, significant progress has been made in developing modified PSA tests such as PSA velocity, PSA density, 4Kscore, PSA glycoprofiling, Prostate Health Index, and the STHLM3 test. PSA, a serine protease, is secreted from the epithelial cells of the prostate. PSA has been suggested as a molecular target for prostate cancer therapy due to the fact that it is not only active in prostate tissue but also has a pivotal role on prostate cancer signaling pathways including proliferation, invasion, metastasis, angiogenesis, apoptosis, immune response, and tumor microenvironment regulation. Here, we summarize the current standing of PSA in prostate cancer progression as well as its utility in prostate cancer therapeutic approaches with an emphasis on the role of PSA in the tumor microenvironment.

Prostate-Specific Antigen Within the Reference Range, Subclinical Coronary Atherosclerosis, and Cardiovascular Mortality.

Although PSA (prostate-specific antigen)-a tumor marker for prostate cancer-has been reported to be associated with cardiovascular disease (CVD) risk factors, studies on the association of PSA with subclinical and clinical CVD remain limited. We examined the association of total serum PSA within the reference range with coronary artery calcium (CAC) score and CVD mortality. A cross-sectional study was performed in 88 203 Korean men who underwent a health checkup exam including cardiac tomography estimation of CAC score. Logistic regression model was used to calculate odds ratios with 95% CIs for prevalent CAC. PSA levels were inversely associated with the presence of CAC. After adjusting for potential confounders, multivariable-adjusted odds ratio (95% CIs) for prevalent CAC comparing PSA quartiles 2, 3, and 4 to the first quartile were 0.96 (0.90-1.01), 0.88 (0.83-0.93), and 0.85 (0.80-0.90), respectively ( P for trend, <0.001). A cohort study was performed in 243 435 Korean men with a mean age of 39.3 years, PSA values of <4.0 ng/mL, and without known CVD or prostate disease who were followed up with for ≤14 years for CVD mortality (median, 7.3 years). CVD deaths were ascertained through linkage to national death records. Hazard ratios and 95% CIs for CVD mortality were estimated using Cox proportional hazards regression analyses. During 1 829 070.1 person-years of follow-up, 336 CVD deaths were identified. After adjustment for potential confounders, multivariable-adjusted hazard ratios (95% CIs) for CVD mortality comparing PSA quartiles 2, 3, and 4 to the lowest quartile were 0.90 (0.66-1.22), 0.79 (0.58-1.08), and 0.69 (0.51-0.93), respectively. Serum total PSA levels within the reference range showed an inverse association with subclinical atherosclerosis and CVD mortality in young and middle-aged Korean men, indicating a possible role of PSA as a predictive marker for subclinical and clinical CVD.

Role of Prostate-Specific Antigen (PSA) in Patients with Benign Prostate Hyperplasia

Role of Prostate-Specific Antigen (PSA) in Patients with Benign Prostate Hyperplasia

Genetic signatures on prostate biopsy: clinical implications

: Prostate cancer management remains a topic of intense debate given favorable disease-specific outcomes for the overwhelming majority of patients. Consensus regarding the role of prostate-specific antigen (PSA) screening among the general male population has been elusive, in part due to questions surrounding the reliability of prostate biopsy results and the difficulty identifying patients with localized disease who will one day progress. Until recently, the Gleason score has been the best prognostic indicator available but issues with interobserver reliability and biopsy sampling error fuel therapeutic indecision and likely lead to over- or under-treatment. Prostate cancer genomic testing takes several forms and offers additional information for predicting the clinical behavior of a tumor. Urine based assays take advantage of the prostate’s anatomic location in the urinary tract to look for genetic material that is associated with finding prostate cancer on a subsequent biopsy. Prostate biopsy tissue samples give direct access to the cancer genome and provide information beyond what is ascertainable using a microscope. If the Gleason score provides a snapshot of the current state of a given prostate tumor, then these tissues based genomic tests offer a window in its future. Several commercially available tests are currently available but only a small number have been FDA-approved thus far. Even the best products have only provided modest gains in prognostic accuracy over existing clinical risk stratification tools, however, this is a key step in the right direction that is nearly a decade behind other malignancies (i.e., breast). There is published data to suggest that these tests can alter physician practice patterns, but to what degree they will ultimately alter clinically significant outcomes remains to be seen.

Clinical implications of the forgotten Skene's glands: A review of current literature

Abstract Introduction The clinical and pathological aspects of the Skene's glands have not been addressed in the current scientific literature. Aim To review the current literature to focus on the clinical and pathological aspects of the Skene's glands. The historical perspective including embryology, anatomy, histology, and current role of prostatic specific antigen (PSA) as a tumor marker of lesions which develop from the Skene's glands, ‘female prostate.’ Material and methods Medline searches were performed to review the current literature regarding Skene's glands pathology, clinical manifestations, diagnosis, role of PSA, and its treatment options. Discussion Anatomical pathology including inflammatory, cystic, solid, benign, and malignant tumors of Skene's glands is emphasized. The unique role of PSA in these lesions is reviewed. Cognizance of periurethral, perimeatal and urethral masses is essential for anatomical pathologists, radiologists, urologists and gynecologists who encounter complex female urethral masses in their clinical practice. Imaging techniques of Skene's glands to diagnose urethral, perimeatal and periurethral masses in female are reviewed. Conclusions The literature of the interesting scientific concepts related to the Skene's glands are reviewed. The role of PSA in these lesions is expanded for diagnoses and treatment options of pathology of the Skene's glands. Methods of imaging are necessary for radiologist, pathologists, and clinicians alike, for the proper treatment of Skene's gland lesions.

Surrogacy analysis of prostate-specific antigen (PSA) decline for improved overall survival (OS) with enzalutamide (ENZ) in AFFIRM.

266 Background: ENZ significantly increased OS for men with metastatic castration-resistant prostate cancer (mCRPC) vs. placebo and significantly decreased PSA levels. However, the prognostic significance and role of PSA falls as a surrogate for OS are not established. Methods: Men in the AFFIRM trial were grouped by maximal unconfirmed PSA decline during the 1st 90 days of treatment in a post-hoc analysis. Each PSA decline criterion was assessed for surrogacy for OS by the proportion of treatment effect (PTE)-explained and Prentice criteria. We also assessed the association of PSA decline with OS, progression-free survival (PFS), and pain response. Results: ENZ improved OS (hazard ratio 0.63, p &lt; 0.001) and was associated with higher rates of PSA declines when compared to placebo (odds ratio &gt; 19.0, p &lt; 0.001). Greater declines in PSA were associated with longer OS, PSA PFS, radiographic PFS, and higher pain response when compared with no PSA decline or PSA increase (table). All decline measures from baseline were highly prognostic for OS and several ( &gt; 0%, ≥ 30%, ≥ 50% declines) explained a proportion of the treatment effect (PTE 1.07–1.29, 95% CI lower bounds &gt; 0.63), in which treatment was no longer significant after adjustment for the decline measures (p &gt; 0.20). Full surrogacy was not demonstrated. Conclusions: In AFFIRM, &gt; 0, ≥30%, and ≥50% PSA declines within 90 days of treatment fulfilled Prentice surrogacy criteria 1–3. Prentice 4, equivalency of survival adjusting for PSA decline outcomes, could not be demonstrated. PSA declines are associated with longer PFS and improved pain response. External prospective validation is needed. Clinical trial information: NCT00974311. [Table: see text]

MP86-17 CLINICALLY SIGNIFICANT INCIDENTAL PROSTATE CANCER DETECTED IN RADICAL CYSTOPROSTATECTOMY SPECIMENS

You have accessJournal of UrologyProstate Cancer: Detection and Screening VII1 Apr 2015MP86-17 CLINICALLY SIGNIFICANT INCIDENTAL PROSTATE CANCER DETECTED IN RADICAL CYSTOPROSTATECTOMY SPECIMENS Swar Shah, Soroush Bazaragani, Gus Miranda, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Swar ShahSwar Shah More articles by this author , Soroush BazaraganiSoroush Bazaragani More articles by this author , Gus MirandaGus Miranda More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1926AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While the focus of radical cystoprostatectomy (RC) is usually a bladder-primary malignancy, incidental prostate cancer is a common finding during pathological examination of the surgical specimen. While mostly clinically insignificant and generally minimally monitored, we sought to characterize clinically significant prostate cancer (csPCA), which may require closer monitoring. Herein, we evaluate the role of prostate specific antigen (PSA) in monitoring csPCA diagnosed at the time of RC. METHODS Using and IRB approved prospective database, we identified 1451 patients who underwent RC between 2003 and 2014 at our institution. Clinically significant prostate cancer was defined as Gleason score ≥7, extra prostatic extension, seminal vesicle involvement, positive surgical margin, and lymph node involvement. PSA values were recorded. In patients with evidence of a biochemical recurrence, complete follow up was obtained. Patients were diagnosed with recurrence based on PSA values or findings on cross sectional imaging. RESULTS We identified a total of 107 patients with csPCA diagnosed at the time of RC, of whom 42 had PSA followup. Average age at the time of RC in these patients was 72.24 ± 9.52 years, with a median follow up of 2.18 years. Mean baseline PSA prior to surgery was 4.45±7.49. Two (4.7%) patients developed a recurrence of their prostate cancer, aged 66 and 65 at the time of surgery, and diagnosed 6.8 and 6.1 years after RC. Both had Gleason grade 3+4 on RC pathology, with no capsule penetration, bladder extension, seminal vesicle involvement, or nodal extension. PSA at the time of recurrence was 0.12 and 43.6 each. PSA peaks were 0.52 and 80.6, respectively. The first was diagnosed based on an enlarged lymph node on routine postoperative cross sectional imaging followed by a steady rise in PSA, which was ultimately biopsy proven PCA. He was unable to undergo radiotherapy because his neobladder would not tolerate the doses of radiation required for prostate cancer and refused ADT. The second was diagnosed based on a markedly elevated PSA, and underwent ADT with a normalization of his markers. He had a marker relapse 3 years after cessation of ADT. Both were alive at last follow up, 6.9 and 9.5 years post-surgery. CONCLUSIONS Less than 5% of patients develop a relapse after diagnosis of csPCA on RC pathology. The relative paucity of recurrence makes it difficult to establish parameters for monitoring, however time to diagnosis (>6 years) suggests long term-follow up in these patients may be necessary to monitor for recurrence. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1082 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Swar Shah More articles by this author Soroush Bazaragani More articles by this author Gus Miranda More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Is prostate-specific antigen a reliable marker for uterine leiomyoma detection?

Now it is accepted that prostate-specific antigen (PSA) is expressed extra prostatically and it is clear that many hormonally regulated female tissues show detectable PSA levels. This study was conducted due to differences of view between researchers about the role of PSA in some women diseases. This study was designed to evaluate the clinical implication of serum PSA measurement in diagnosis or management of patients with uterine myoma. This was a case-control study. A total of 224 patients included in this study. Serum specimens were isolated and were stored at -70°C until all specimens were completed. Wilcoxon's rank-sum test was used to identify statistically significant differences between the total PSA and free PSA measurements in patient groups. We noticed that there is no statistical significant correlation between total or free serum PSA level of cases with uterine myoma and control group (P = 0.433 and 0.700, respectively). Furthermore, no statistical difference was considered either in size or frequency of leiomyomas and free or total serum PSA (P = 0.126 and 0.433 and P = 0.997 and 0.442, respectively). We concluded that serum PSA measurement has little clinical utility in diagnosis or management of uterine leiomyoma.

PSA Screening: A Discussion Based on the USPSTF Recommendations and the AUA and EAU Guidelines

The role of prostate-specific antigen (PSA) screening in the adult male population is not clearly defined. Although PSA has been shown to be the single most significant predictive factor for identifying men at increased risk of developing prostate cancer (PCa), PSA screening may lead to an increase in unnecessary prostate biopsies, significant over-diagnoses of PCa, and overtreatment of the disease, each of which may contribute to untoward complications and/or side effects. We reviewed PubMed and MEDLINE for articles published between 1970 to December 2013 that discuss the clinical applications of PSA as a screening test, in addition to clinical trials, evidence-based recommendations and guidelines from major medical organizations both in the U.S. and worldwide regarding prostate cancer screening. We also reviewed the current PSA screening recommendations of the United States Preventive Services Task Force (USPSTF), the American Urological Association (AUA), and the European Association of Urology (EAU). A total of 110 publications were reviewed. Results from the European Randomized Study of Screening for Prostate Cancer (ERSPC), the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, and Göteborg trials regarding prostate screening are conflicting: The ERSPC and Göteborg trials show a reduction in prostate cancer mortality, but the PLCO trial shows no benefit. The USPSTF has assigned a grade D recommendation to PSA screening, that is, it has recommended against screening for men in the general U.S. population, regardless of age. The AUA updated its guideline in 2013 to reflect its belief that men under the age of 40 or over the age of 70 with less than a 10- to 15-year life expectancy should not be offered or subjected to PSA screening. Men between the ages of 40 and 54 with risk factors (positive family history or African American race), or men of average risk between the ages of 55 and 69 or older if life expectancy is greater than 10 years should be counseled on the risks and benefits of PSA screening and undergo PSA screening if desired. The EAU recommends obtaining a baseline PSA at age 40 to 45 and adapting subsequent screening intervals to that baseline. The diversity of methodology from randomized trials such as the PLCO, ERSPC, and Göteborg, allows for significant flexibility in interpretation, making it difficult to apply trial outcomes to substantiate universal recommendations. Clinical factors, such as age, race, family history, 10-year life expectancy, and patient preferences, should be taken into account. Variations on PSA-based screening, including age-adjusted PSA, PSA density (PSAD), PSA velocity (PSAV), and percentage of free PSA (%fPSA), may be used to improve the performance of the test. PSA testing may serve as the foundation for a more risk-based assessment. Finally, it should be noted that the decision to screen or not to screen using PSA testing is best made by the patient and his urologist after weighing its advantages and disadvantages.

Role of Prostate Specific Antigen, Digital Rectal Examination and Trans Rectal Ultrasonography in the Diagnosis of Prostate Cancer in Patients with Lower Urinary Tract Symptoms

Objectives: The aim of this study is to compare the roles of prostate-specific antigen (PSA), digital rectal examination (DRE) and transrectal ultrasonography (TRUS) in the detection of prostate cancer among patients presenting with lower urinary tract symptoms (LUTS) and having an International Prostate Symptoms Score (IPSS) of not less than 7. Material and Methods: This study was carried out in I.P.G.M.E.R and S.S.K.M Hospital, Kolkata, West Bengal, India, from March 2011 to March 2012. Sixty patients presenting with LUTS and with an IPSS not less than 7 had been screened for prostate cancer using PSA estimation, DRE and TRUS. Transrectal sextant prostate biopsy was performed in all patients. Results: The PSA estimation revealed 85% sensitivity and 72.5% specificity for the patients with a serum total PSA level >10 ng/ml. The positive predictive value (PPV) was 60.7%. If 4 ng/ml is taken as a lower cutoff value for serum total PSA, the sensitivity increases to 95%, whereas specificity reduces to 46.66% and PPV becomes 50%. DRE alone showed 60% sensitivity, 92.5% specificity and 80% PPV for the diagnosis of carcinoma prostate. TRUS has the highest sensitivity (75%) and highest specificity (85%). However, the PPV was 71.43%. When DRE and serum PSA >10 ng/ml were combined, the sensitivity and specificity were raised to 90% and 70% respectively. The PPV was 60%. This was almost comparable with the combination of DRE, serum PSA >10 ng/ml, and TRUS, which has a 90% sensitivity and 85% specificity. The PPV was 75%. Conclusion: None of the single screening tools had that much efficacy in differentiating carcinoma of prostate from benign prostatic hyperplasia in patients with LUTS. Combining PSA, DRE and TRUS increases sensitivity, specificity and PPV of PC detection.