Total Prostate-specific Antigen Serum Levels Research Articles

Correlation Analysis between Apparent Diffusion Coefficient of Prostate Cancer and other Prostate Cancer Indicators

Background: There are very few reports on the correlation between the apparent diffusion coefficient (ADC) of magnetic resonance parameters and other laboratory indicators of prostate cancer in China, and there is no unified clinical conclusion at present from the other parts of the world. Therefore, this study analyzed the correlation between ADC and laboratory indicators, such as serum total prostate specific antigen (TPSA), complex prostate specific antigen (CPSA), free prostate specific antigen (FPSA), Gleason score, and left and right diameters of the prostate so as to provide a basis for the diagnosis and treatment of prostate cancer. Methods: A total of 104 patients of all age groups with prostate cancer diagnosed in the General Hospital of Wanbei Coal and Electricity Group, Wanbei, China, from January 2017 to December 2022 were retrospectively analyzed as the experimental group. At the same time, 63 patients with benign prostatic hyperplasia who received health examinations were selected as the control group. TPSA, CPSA, FPSA, CPSA/TPSA, FPSA/TPSA, Gleason score, left and right diameters of the prostate, and magnetic resonance parameter ADC were detected in all patients. At the same time, we analyzed the correlation between ADC and other parameters in prostate cancer patients. Results: The serum levels of TPSA, CPSA, and FPSA in prostate cancer patients were significantly higher (P<0.001) than in those in the control group. The differences between CPSA/TPSA and FPSA/TPSA in the two groups were not statistically significant. Meanwhile, ADC and left and right diameters of the prostate were significantly lower in prostate cancer patients than in subjects in the control group, and the differences were statistically significant (P<0.001). In addition, serum TPSA, CPSA, and FPSA in high-risk prostate cancer patients were found to be significantly higher than in cases in the medium-risk and low-risk groups. The results of our study also revealed that ADC was moderately negatively correlated with FPSA (r=-0.415, P<0.001) and weakly negatively correlated with TPSA (r=-0.222, P=0.024). Conclusion: There is a correlation between ADC, TPSA, and FPSA in patients with prostate cancer, and there were significant differences in TPSA, CPSA, and FPSA between patients with prostate cancer and patients with benign prostatic hyperplasia. The three parameters can be combined for the diagnosis of prostate cancer.

Investigation of the relationship between endothelial nitric oxide synthase T786C polymorphism and PSA, PSA derivatives, and prostate cancer in the Turkish population.

Prostate cancer is a slowly progressing cancer. However, it has remained a major medical problem for affected men. Risk factors of prostate cancer include age, race, and prostate cancer family history. Prostate cancer may occur at different frequencies between ethnic populations and countries. Currently, studies on genetic risk factors in prostate cancer aetiology have been increasing. Due to the importance of changes in endothelial nitric oxide synthase in carcinogenesis, we aimed to reveal whether eNOS T786C polymorphism is associated with prostate cancer. Archival samples included in this study were whole blood samples taken from patients who were grouped according to prostate biopsy pathology results (BPH, n: 42; PCa, n: 48) and from healthy participants (controls, n:27). DNA was isolated from these whole blood samples and real-time polymerase chain reaction analysis was performed for endothelial nitric oxide synthase T786C polymorphism with LightCycler 480 II. Measured free and total prostate-specific antigen serum levels were evaluated retrospectively. There was a statistical difference between patient-healthy control and control-healthy control groups regarding genotype distributions for eNOS T786C hism. Controls were more likely to have TC and CC genotypes and C alleles than the other two groups. Compared to other groups, the percentage of the eNOS786C allele in the control group was found to be higher. As a result of these data, it can be thought that carrying the allele may be protective against the disease.

PREVALENCE OF VITAMIN D INADEQUACY AMONG ORTHOPEDIC SURGEONS

Background: Indoor workers including healthcare professionals are at high risk to develop vitamin D insufficiency and deficiency, due to lifestyle and limited sunlight exposure. Additionally, common health problems in aging men are vitamin D inadequacy, hypogonadism and prostate cancer.
 Objective: The study aimed to determine the prevalence of vitamin D inadequacy, testosterone and prostate specific antigen (PSA) among orthopedic surgeons with different ages and regions of residence.
 Methods: This cross-sectional study was conducted at the annual meeting of the Royal College of Orthopedic Surgeons of Thailand (RCOST) in October 2017. All participants were orthopedic surgeons working in different regions in Thailand. They received blood examination for vitamin D (25-hydroxyvitamin D) levels, total testosterone and total PSA serum levels.
 Results: A total of 257 orthopedic surgeons participated in the study. The prevalence of vitamin D inadequacy was 71.98%. Old age group (≥60 years old) had significantly higher total vitamin D than young age group (<60 years old) (p=0.014). Participants from eastern region had significantly higher total vitamin D than Bangkok and southern regions (p=0.015). Interestingly, the prevalence of low testosterone levels was 13% which occurred significantly in the age group ≥40 year (p=0.004). Additionally, the prevalence of high PSA levels was 4.67%. Even though the old age group had significantly higher PSA than the young age group (p< 0.001), no correlation was found between region and total PSA level.
 Conclusion: The prevalence of vitamin D inadequacy among Thai orthopedic surgeons was surprisingly high. This data provide important information to promote greater self-awareness to reduce the possible consequences associated with vitamin D inadequacy. Vitamin D supplementation including prevention strategies need to be promoted among healthcare professionals.

Прогностическое значение простатспецифического антигена при определении показаний к первичной биопсии предстательной железы

To investigate the diagnostic accuracy of PSA and its derivatives in detecting benign and malignant diseases of the prostate after an initial prostate biopsy. The current study analyzed 65 initial biopsies performed due to an elevated serum PSA level and compared them with the results of extended PSA testing with the use of PSA derivatives. The histological findings consistent with PCa were found in about 30% of initial biopsies performed due to elevated serum levels of total PSA. The incidence of histologically confirmed PCa increased with age, and 70-79 year old men were more likely to have it than 60-69 years old patients. PSA density in 85% of PCa cases exceeded that for benign prostatic hyperplasia (BPH). In all PCa patients, PHI and free /total PSA fraction were greater than 25 and less than 0.15, respectively. In most patients with BPH, the PHI and free /total PSA fraction did not exceed 25 and were greater than 0.15. 1. Initial biopsy triggered by elevated serum level of total PSA allows detection of PCa in about 30% of cases. 2. The age of 60 years and older should be regarded as a risk factor for PCa. The probability of malignant transformation of prostate epithelial cells in men over 70 years of age is greater than in 60-69-year-olds. 3. The density of PSA in men with morphologically verified PCa is statistically significantly greater than that in men with BPH and the threshold value in 85% of cases. 4. Determination of PHI and free/total PSA fraction can improve the accuracy of predicting malignant lesions of the prostate and adjust the indications for histological examination, reduce the number of unnecessary biopsies. 5. When defining indications for initial prostate biopsy in cases with serum PSA varying from 2 to 10 ng/ml, PSA derivatives should be used, including PSA density, prostate health index, and the free /total PSA fraction.

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.

Low percentage of free prostate-specific antigen (PSA) is a strong predictor of later detection of prostate cancer among Japanese men with serum levels of total PSA of 4.0 ng/mL or less.

To investigate the effect of the percentage of free prostate-specific antigen (%fPSA) on future prostate cancer risk. We examined serum total PSA (tPSA) and %fPSA annually in a prostate cancer-screening cohort between July 2001 and June 2011. Men with tPSA >4.0 ng/mL or tPSA of 2.0-4.0 ng/mL with %fPSA ≤12% were screened as positive and were recommended to undergo a biopsy. The study population consisted of 6368 men, aged 40-79 years, who had tPSA ≤4.0 ng/mL at initial screening and who subsequently underwent 1 or more screenings. We calculated the cumulative risk and hazard ratio of prostate cancer stratified by the initial %fPSA groups as quartiles of prostate cancer patients. During a median follow-up of 36 months, 119 men were diagnosed with prostate cancer. The lowest quartile of %fPSA (<13.3%) was associated with a 21.2-fold higher risk of having prostate cancer compared with the highest quartile (>22.2%). For the subset with an initial tPSA ≤1.0 ng/mL, all men diagnosed with cancer had an initial %fPSA ≤33.3% (median). For the subset with tPSA >1.0 ng/mL, men with %fPSA ≤23.0% (median) had significantly higher risk for cancer than those with %fPSA >23.0% (P <.0001). Of the 114 men with prostate cancer in whom pathologic findings were available, 79 (69.3%) had a Gleason score ≥3 + 4 = 7. A low %fPSA is a strong predictor of a subsequent diagnosis of prostate cancer among men with tPSA levels ≤4.0 ng/mL. Measurement of %fPSA might enhance the detection of high-grade cancer that warrants aggressive treatment.

Are Total Prostate-specific Antigen Serum Levels in Cirrhotic Men Different From Those in Normal Men?

To determine the serum total prostate-specific antigen (tPSA) levels in cirrhotic men and compare them with those in noncirrhotic men. We prospectively evaluated 113 cirrhotic patients listed for liver transplantation using the serum tPSA, total testosterone level, and Child-Pugh liver function score according to age and severity of liver disease. The tPSA levels were compared with those of 661 healthy men. The Mann-Whitney U test was used for statistical analysis, with a significance level of .05. The median age of the cirrhotic and noncirrhotic patients was 55 years (range 28-70) and 58 years (range 46-70), respectively (P < .01). However, when stratified by age group (<49, 50-59, and >60 years), this difference was not significant. The median serum tPSA level was 0.3 ng/mL (range 0.04-9.9) and 1.3 ng/mL (range 0.04-65.8) in the cirrhotic and noncirrhotic group, respectively (P < .0001). Stratifying both groups according to age, the cirrhotic patients had significantly lower tPSA levels than did the noncirrhotic patients. According to the Child-Pugh score (A, B, and C), Child-Pugh class C patients had significantly lower tPSA levels than did Child-Pugh class A patients and also had lower testosterone levels than did Child-Pugh class A and B patients. The tPSA levels correlated significantly with the testosterone levels in the cirrhotic patients (P = .028). The results of our study have shown that cirrhotic patients have approximately 4 times lower serum tPSA levels than noncirrhotic men. Patients with more severe liver disease have lower tPSA and testosterone levels than patients less affected. The tPSA levels in cirrhotic men are affected by the total testosterone levels.

Comparison of several combinations of free, complexed, and total PSA in the diagnosis of prostate cancer in patients with urologic symptoms

Objectives To compare the diagnostic efficacy of prostate-specific antigen (PSA) and the PSA fractions (free PSA [fPSA] and complexed PSA [cPSA]) in the differential diagnosis between prostate cancer and benign prostatic hyperplasia. Methods We measured the serum levels of total PSA (tPSA; Hybritech and Bayer), fPSA (Hybritech), and cPSA (Bayer) in 72 patients with prostate cancer and 128 patients with benign prostatic hyperplasia. Results Receiver operating characteristic curves were used for comparison of these tests. The greatest area under the curve was observed for the fPSA/cPSA ratio and the fPSA/tPSA ratio (0.757 and 0.754, respectively). The substitution of the fPSA/tPSA ratio with the fPSA/cPSA ratio in the diagnostic scheme of prostate cancer improved the diagnostic accuracy, with similar sensitivity and an increment in specificity (41% versus 45%). Conclusions The fPSA/cPSA ratio ensures a reduction in negative biopsies in the PSA gray zone. We suggest substituting the fPSA/tPSA ratio with the fPSA/cPSA ratio for patients with a PSA level between 4 and 10 ng/mL.

PSA and anthropometric measurements among Amazon Indians: an evaluation of the Parkatejê community

PSA (prostate-specific antigen) screening for early detection of prostate cancer in a native community is of great epidemiological importance. The study was conducted with the objective of verifying the occurrence of prostate cancer among members of an Amazon community, as well as its possible relationship to acculturation and overweight (body mass index). Lifestyle and anthropometric information was collected from a group of 22 men, presumedly over age 50, members of an isolated community of 363 Amazonian Indians--self-denominated Parkatejê and Kykatêjê--from Pará state, in Northern Brazil. In addition to physical and hematological exams, total and free PSA dosages were performed. Total PSA serum levels ranged from 0.35 to 25.8 ng/ml. Three subjects had PSA levels greater than 4.0 ng/ml, and another two had levels between 2.5 and 4.0 ng/ml. Prostate biopsies performed on two subjects indicated the presence of prostate adenocarcinoma in one of them and of intraepithelial neoplasia on the other. Overweight (BMI> or =25 Kg/m2) and waist-to-hip ratio > or =0.9 were observed in 68.1% and 72% of subjects, respectively. Changes in nutritional habits caused by contact with civilization, such as the substitution of more caloric foods for the traditional game and vegetable fiber are increasing the prevalence of overweight among the community. In view of the association between prostate cancer incidence, high-fat diet, and less physical activity, it can be assumed that further cases of prostate neoplasia will occur in the future, since several community members already have high PSA serum levels.

Determination of the Percentage of Free Prostate–Specific Antigen Helps to Avoid Unnecessary Biopsies in Men with Normal Rectal Examinations and Total Prostate–Specific Antigen of 4–10 ng/ml

Objective: To assess the usefulness of measuring the percentage of free prostate–specific antigen (PSA) in serum to reduce the number of prostate biopsies in men with serum PSA levels between 4 and 10 ng/ml and benign prostate examinations. Materials and Methods: The percentage of free PSA (Immulite^®) in serum was analyzed prospectively in 180 men with benign digital rectal examinations and total PSA serum levels of between 4 and 10 ng/ml. All patients underwent ultrasound–guided sextant prostatic biopsies. Sensitivity, specificity and positive and negative predictive values were calculated as well as the percent of patients in which biopsies could have been avoided for various cutoff values of the percentage of free PSA as an indicator for biopsy. Influence of age in the determination of cut points was evaluated. Results: Cancer was detected in 22.2% (40/180) of the patients. Mean percentage of free PSA was 13.4% in patients with cancer and 18.9% in patients with benign prostatic hyperplasia (p = 0.001). Using a percentage of free PSA cutoff of 22% or less as a criterion for performing prostatic biopsy would have detected 95% of cancers, avoided 25% of benign biopsies and yielded a positive predictive value of 29% in patients who underwent biopsy. Mean percent of free PSA values increased as mean subject age increased, influencing the calculation of cut points, sensitivity and specificity. Leaving the cut point constant across all age groups will oblige older patients to undergo an increased number of unnecessary biopsies, although allowing for higher sensitivity in younger men. Conclusions: Measurement of the percentage of free serum PSA improves specificity of prostate cancer detection in patients with elevated total serum PSA levels and benign prostate examinations. Subject age seemed to influence the determination of optimal cut points.

Serum Levels of Free and Total Prostate-Specific Antigen in Males with Liver Cirrhosis

Objectives: We examined the serum concentrations of total and free prostate-specific antigen (PSA) from patients with liver cirrhosis to clarify the influence of liver function on serum PSA levels. Methods: Serum concentrations of total and free PSA, as well as the free/total PSA ratio were measured in 75 male patients with histologically confirmed liver cirrhosis. As a control group, 75 age-matched healthy blood donors were studied. Results: The serum levels of total PSA in liver cirrhosis patients were significantly lower than those in controls (p = 0.0004). However, the serum free/total PSA ratios in liver cirrhosis patients were significantly higher than those of controls (p < 0.0001). Conclusions: Our results suggest the absence of an obvious clearance disturbance of serum PSA as a result of severe hepatic dysfunction and offer caution against the utility of standard cutoff values of serum PSA or free/total PSA ratios in the detection and staging of prostate cancer in men with severe liver dysfunction.

SERUM LEVELS OF TOTAL AND FREE PROSTATE SPECIFIC ANTIGEN IN MEN ON HEMODIALYSIS

Purpose The measurement of prostate specific antigen (PSA) is widely used in screening programs for early detection of prostate cancer. It has been recently shown that the ratio of free-to-total PSA in serum is lower in malignant than in nonmalignant prostatic disorders and, therefore, might be a parameter to improve screening specificity. We determine the influence of renal failure on serum levels of total and free PSA, and free-to-total PSA ratio. Materials and Methods Serum concentrations of total and free PSA, and free-to-total PSA ratio were measured in 93 men undergoing hemodialysis. The control group consisted of 2,298 healthy blood donors. Results Serum levels of total PSA were not significantly different between control and hemodialysis patients. Serum free PSA and free-to-total PSA ratio of hemodialysis patients were significantly higher than those of controls (p <0.01 to 0.001). However, these values did not change in uremic patients after hemodialysis. Although serum total and free PSA levels increased with each decade of age, they did not correlate with age in hemodialysis patients. Conclusions Serum free PSA as well as total PSA is not eliminated by hemodialysis, and elevated levels of free PSA and free-to-total PSA ratio in hemodialysis patients may be caused by a concomitant decrease in binding proteins. The reference ranges for total and free PSA, and free-to-total PSA ratio may not be necessarily beneficial in hemodialysis patients.

INFLUENCE OF FINASTERIDE ON FREE AND TOTAL SERUM PROSTATE SPECIFIC ANTIGEN LEVELS IN MEN WITH BENIGN PROSTATIC HYPERPLASIA

Purpose Finasteride therapy for benign prostatic hyperplasia (BPH) results in a marked lowering of serum prostate specific antigen (PSA) levels. However, little is known about the effect of finasteride on unbound or free serum levels of PSA. Such information would be important since percent free PSA may substantially improve the cancer specificity of PSA testing. Thus, we prospectively studied the effect of finasteride therapy on total and free serum PSA levels. Materials and Methods In a randomized, placebo controlled, double-blind trial 40 men with histologically confirmed BPH (age range 52 to 78 years) were treated with either 5 mg. finasteride daily (26 patients) for 9 months or placebo (14) for 6 months. Prostate volume was assessed by transrectal ultrasound. Serum levels of free and total PSA were measured from archived serum samples stored at −70C at baseline and for as long as 9 months of treatment. Results In the finasteride group mean total PSA levels declined from 3.0 ng./ml. at baseline to 1.5 ng./ml. after 6 months of treatment (50% decrease, p < 0.01). In the placebo group, with similar baseline levels, no significant change was observed. PSA density declined significantly in finasteride treated men (p <0.01) but not in men receiving placebo. The mean percent free PSA (13 to 17% at baseline) was not altered significantly by finasteride or placebo. Conclusions Total PSA serum levels decreased by an average of 50% during finasteride therapy but percent free PSA did not change significantly. This information is potentially useful in the interpretation of PSA data used for early detection of prostate cancer in men receiving finasteride. However, further studies are required to demonstrate the use of percent free PSA to detect the development of cancer.