Serum Prostate-specific Antigen Levels In Men Research Articles

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.

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.

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.

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.

Patients with Elevated versus Non-Elevated Prostate Specific Antigen Levels before Suprapubic Prostatectomy: Long-Term Postoperative Follow-Up and Risk for Rising Prostate Specific Antigen and Detection of Prostate Cancer

Objective: Prostate specific antigen (PSA) is one of the most widely applied tumor markers in oncology. The marker is, however, not cancer-specific and may be elevated under other conditions. As prostate cancer may develop after surgery for benign prostate hyperplasia, postoperative follow-up of serum PSA levels is suggested in patients with at least a 10 year life expectancy. We evaluated the preoperative and monitored postoperative serum PSA levels in men who underwent suprapubic prostatectomy (SPP) for benign prostate hyperplasia, and specifically examined the rate of cancer detection in patients who had a non-elevated versus elevated age-related preoperative PSA. Patients and Methods: Two hundred and ninety-two patients who presented with benign histopathology after SPP, completed postoperative follow-up. Of those, 101 patients were found to have elevated preoperative PSA levels and a negative transrectal biopsy before the operation. The other group included 191 patients with preoperative PSA within age related limits. Results: PSA levels continued to be elevated in 11.8% of patients in the elevated PSA group compared with 3.5% in the non-elevated PSA group. Incidental surgical specimen cancer detection rate was 7 (6.5%) and 3 (1.5%) whereas follow-up cancer detection rate was 4 (3.9%) and zero in the elevated PSA group and non-elevated PSA group, respectively. In a logistic regression model, 2 factors were found to be statistically significant: age – the older the patient undergoing the operation, the greater was the likelihood to develop malignancy on follow-up. The second factor was the ratio between preoperative and postoperative PSA (prePSA – postPSA)/prePSA. Conclusions: This study is the first to compare long-term follow-up in patients after SPP with preoperative elevated PSA levels to those who have normal preoperative levels. The first group was found to have an increased risk incidental cancer in the surgical specimen, and of elevated PSA levels and eventually development prostate cancer upon follow-up.

Effectiveness of Antibiotics Given to Asymptomatic Men for an Increased Prostate Specific Antigen

Although there is controversy surrounding this subject, some urologists in daily practice often prescribe antibiotics before biopsy to men with a newly increased prostate specific antigen. We evaluated the effects of antibiotics on serum total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density in men with prostate specific antigen between 4 and 10 ng/ml and normal digital rectal examination. We also investigated the incidence of prostate cancer after antibiotic treatment by performing prostate biopsies in all patients regardless of posttreatment prostate specific antigen. Between May 2006 and April 2008 a total of 100 men with total prostate specific antigen between 4 and 10 ng/ml were enrolled in this study. In addition to total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density values were evaluated for all of the patients. Patients with pathological digital rectal examination and urinalysis were excluded from the study. All patients received 400 mg ofloxcacin daily for 20 days. After treatment the patients were reevaluated. Regardless of the total prostate specific antigen value after therapy transrectal ultrasound guided prostate biopsy was performed. Overall 23 men (23%) had histologically proven prostate cancer on biopsy. Mean total prostate specific antigen, free prostate specific antigen and prostate specific antigen density decreased after treatment in patients with and without prostate cancer. However, these reductions within these parameters were not significantly different between patients with and without prostate cancer. Only percent free prostate specific antigen change after treatment was found to be significantly different between patients with and without prostate cancer (p = 0.015). In 17 of the 100 men total prostate specific antigen after treatment was less than 4 ng/ml and of these 5 (29.4%) had prostate cancer on biopsy. Although antibiotic therapy will decrease serum total prostate specific antigen, it will not decrease the risk of prostate cancer even if the prostate specific antigen decreases to less than 4 ng/ml. Therefore, prescribing antibiotics for asymptomatic men with a newly increased prostate specific antigen may not be an appropriate method of management.

Serum Prostate-Specific Antigen Levels in Men With Type 2 Diabetes

The aims of this study were to examine if serum prostate-specific antigen (PSA) levels are lower in men with type 2 diabetes compared with those in healthy men and to investigate what factors may be associated with serum PSA levels in men with type 2 diabetes. We compared the serum PSA levels in 224 diabetic men with those in 1,293 healthy men and investigated the relationships between serum PSA levels and various variables. Except for men aged 40-49 years, serum PSA levels were lower in diabetic men than in healthy men. Multiple regression analysis demonstrated that age, BMI, and presence of diabetes were independent determinants of serum PSA level. Serum PSA levels were lower in diabetic men compared with those in healthy men, which is in line with previous reports that patients with type 2 diabetes are at a decreased risk of prostate cancer.

Lycopene and Soy Isoflavones in the Treatment of Prostate Cancer

Dietary intake of lycopene and soy has been associated with a lower risk of prostate cancer. In vitro studies with lycopene and genistein, a soy isoflavone, have shown induction of apoptosis and inhibition of cell growth in androgen-sensitive (LNCaP) and androgen–independent (PC3 and VeCaP) prostate cancer cell lines. In a previous Phase II clinical trial in prostate cancer patients, we observed prostate-specific antigen (PSA) stabilization with soy isoflavone intake. In this Phase II clinical trial, we investigated the efficacy of lycopene alone or in combination with soy isoflavones on serum PSA levels in men with prostate cancer. To be eligible for the study, men with prostate cancer had to have rising serum PSA following local therapy or while on hormone therapy. Study population included 71 eligible patients who had 3 successive rising PSA levels or a minimum PSA of 10 ng/ml at 2 successive evaluations prior to starting therapy. Subjects were randomly assigned to receive a tomato extract capsule containing 15 mg of lycopene alone (n = 38) or together with a capsule containing 40 mg of a soy isoflavone mixture (n = 33) twice daily orally for a maximum of 6 mo. One patient on the lycopene arm did not receive therapy due to his inability to ingest the study pill. There was no decline in serum PSA in either group qualifying for a partial or complete response. However, 35 of 37 (95%) evaluable patients in the lycopene group and 22 of 33 (67%) evaluable patients in the lycopene plus soy isoflavone group achieved stable disease described as stabilization in serum PSA level. The data suggest that lycopene and soy isoflavones have activity in prostate cancer patients with PSA relapse disease and may delay progression of both hormone-refractory and hormone-sensitive prostate cancer. However, there may not be an additive effect between the 2 compounds when taken together. Future studies are warranted to further investigate the efficacy of lycopene and soy isoflavones in prostate cancer as well as the mechanism of potential negative interaction between them.

Association between genetic polymorphisms in the prostate-specific antigen gene promoter and serum prostate-specific antigen levels.

Recent evidence suggests that genetic variation in the promoter of the prostate-specific antigen (PSA) gene may contribute to individual variation in serum PSA levels. However, polymorphisms associated with variations in PSA levels have not been identified. We used the polymerase chain reaction to amplify the promoter region of the PSA genes (nucleotide positions -3873 to -5749 with respect to the start of transcription) of 409 healthy white men at risk for lung disease. Polymerase chain reaction products were sequenced to identify polymorphisms in the PSA gene promoter and to genotype the men for common single nucleotide polymorphisms (SNPs) and were cloned into luciferase reporter constructs to assay PSA promoter activity in human LNCaP prostate cancer cells. Analysis of variance was used to test the association of polymorphism frequencies with mean serum PSA levels. All statistical tests were two-sided. The -4643G/A SNP (G allele) had a 21.2% prevalence and was associated with increases in serum PSA levels (P =.017) and PSA promoter activity (P<.001). The -5412C/T SNP (C allele) had a 22.0% prevalence and was associated with an increase in serum PSA levels (P =.0015). The -5429T/G SNP (G allele) had a 23.0% prevalence, was associated with an increase in serum PSA levels (P =.021), and was in linkage disequilibrium with the -5412C/T SNP. The promoter activity of the -5412 C/-5429 G haplotype was higher than that of the -5412 T/-5429 T haplotype (P<.001). Genetic variations in the PSA promoter are associated with serum PSA levels in men without prostatic disease. PSA promoter genotype information may help to refine models of PSA cutoff values.

Evaluation of the effect of spinal cord injury on serum PSA levels

Objectives. Prostatic structure and secretory activity are thought to be influenced by autonomic innervation of the prostate. Prostatic denervation is especially likely in patients with spinal cord injury (SCI) at the level of the cauda equina or the conus medullaris, where the peripheral nerve supply to the prostate may be specifically damaged. This may result in changes in serum prostate-specific antigen (PSA) levels, either directly or indirectly. Therefore, we measured serum PSA levels and also studied the influence of factors such as age, catheterization, duration of SCI, urinary tract infection, and history of cystitis on serum PSA values in men with SCI. Methods. Serum PSA levels were determined in 79 men with SCI (age older than 40 years) using banked sera by the Abbott MEIA PSA assay. Variables such as age, catheterization, duration of SCI, urine culture results, and history of cystitis were obtained from a review of patient records. Comparisons were made with a randomly selected, non-SCI control population of 501 men, 40 to 89 years old, who underwent serum PSA determination at our institution. Statistical comparisons were performed using the Mann-Whitney U test (nonparametric), since the populations were not normally distributed. Multivariate logistic regression analysis was used to assess the correlation between the various factors and the serum PSA levels in men with SCI. Results. No statistically significant differences were found in the median serum PSA values between the SCI group and the non-SCI control population. The age-specific PSA values obtained in the SCI group were also comparable to those reported for the general population at large. Age ( P <0.03) and the presence of a catheter ( P <0.0002) were the only two factors that were correlated with higher serum PSA values in the SCI group by regression analysis. Conclusions. Men with SCI tended to have serum PSA value distributions that were similar to those of the general population. However, those in the SCI group who had indwelling catheters were more likely to have higher PSA values at baseline, as were older men with SCI.

Comparison of percent free prostate-specific antigen levels in men with benign prostatic hyperplasia treated with finasteride, terazosin, or watchful waiting

Objectives Finasteride is known to lower total serum prostate-specific antigen (PSA) levels by approximately 50%. Terazosin is thought to have little or no effect on serum PSA concentration. The objective of our study was to determine the effect of finasteride and terazosin on serum total and serum free PSA levels and the ratio of free to total PSA. Methods We identified 69 men with symptomatic benign prostatic hyperplasia (BPH) who had been receiving 5 mg/day (n = 33) of finasteride or 2 to 5 mg/day (n = 14) of terazosin or no therapy (“watchful waiting”) (n = 22). The three groups were compared with respect to pretreatment total serum PSA levels and post-treatment total, free, and percent free serum PSA levels. Results Median (± semi-interquartile range [SIR]) pretreatment total serum PSA levels (ng/mL) were not significantly different in men taking finasteride (2.8 ± 1.9), terazosin (2.2 ± 2.5), or undergoing watchful waiting (5.5 ± 1.4) ( p = 0.12). The median (± SIR) post-treatment total serum PSA levels (ng/mL) were significantly lower in the finasteride group (1.1 ± 1) when compared with the terazosin (2.5 ± 1.5) or watchful waiting (4.3 ± 2.8) groups ( p = 0.016). Only the finasteride group had significantly lower post-treatment total serum PSA levels compared with pretreatment levels. The median (± SIR) post-treatment free PSA levels were significantly lower in the finasteride group (0.26 ± 0.16) compared with the terazosin (0.54 ± 0.5) and watchful waiting (0.85 ± 0.5) groups ( p = 0.0015). However, the median (± SIR) percent free PSA was not significantly different in the finasteride (23 ± 6), terazosin (22 ± 4), and watchful waiting (25 ± 5) groups ( p = 0.66). Conclusions Finasteride appears to lower total and free PSA levels equally in men with BPH and does not appear to change the ratio of free to total serum PSA. Terazosin does not appear to alter total or free serum PSA levels in men with BPH. The percent free PSA could potentially be used to screen for prostate cancer in men taking finasteride. Prospective studies are needed to further evaluate this issue.

Pitfalls in Interpreting Prostate Specific Antigen Velocity

Purpose The concept of prostate specific antigen (PSA) velocity as an improved marker for prostate cancer detection is intriguing. However, before this concept is applied to individual patients several confounding parameters must be addressed. We determined the variability of serum PSA levels in men without prostate cancer. Materials and Methods We reviewed data from a prostate cancer screening program, and determined inter-assay and individual variability of the serum PSA values for a 2-year followup period in 265 men clinically free of prostate cancer. Results Our average inter-assay coefficient of variation was 7.5 percent. Therefore, we considered only PSA changes exceeding plus/minus 15 percent as significant. Fluctuations in serum PSA occurred in 78 percent of the men during the observation period, and 12.5 percent had at least a single PSA increase exceeding 0.75 ng./ml. per year. Fluctuations were noted throughout the entire range of serum PSA levels but became progressively larger with an increasing mean PSA. Conclusions The inter-assay variability must be considered when interpreting PSA velocity. Individual fluctuations in serum PSA dictate an observation period of at least 2 years before PSA velocity is considered abnormal.