Serum Total Prostate-specific Antigen Levels Research Articles

Predictive values and relationships of serum PSA levels, delta neutrophil index, neutrophil-lymphocyte ratio and other hematological parameters in patients with acute prostatitis.

This study aimed to evaluate the predictive values and relationships of serum prostate-specific antigen (PSA) levels, delta neutrophil index (DNI), neutrophil-lymphocyte ratio (NLR), and other hematological parameters in patients diagnosed with acute prostatitis. Serum PSA levels and hemogram parameters of patients diagnosed with acute prostatitis were retrospectively analyzed. Healthy patients of the same age group were assigned to the control group. WBC, neutrophil, lymphocyte, thrombocyte (PLT), mean platelet volume (MPV), plateletcrit (PCT), NLR, and DNI were determined. Serum total PSA and C-reactive protein (CRP) levels were also assessed. Total PSA levels (3.48 [1.11-6.66]) in the acute prostatitis (AP) group were significantly higher than those of healthy men (0.82 [0.47-1.39]) (p < 0.001). Total CRP levels (3.88 [1.50-22.03]) in the AP group were significantly higher than those in healthy men (1.15 [0.89-2.00]) (p < 0.001). The sensitivity and specificity of PSA at a cutoff value of 1.52 were 68.4% and 79.7%, respectively. The NLR value in the AP group was 2.62 (1.87-4.42), compared to 1.63 (1.18-2.20) in the healthy group (p < 0.001). Differences in WBC, neutrophil, and lymphocyte counts were also statistically significant (p < 0.001). There were no significant differences in PLT, PCT, or DNI values. Significant positive correlations were observed between PSA, CRP, and DNI values (all p < 0.001). This study demonstrated the usefulness of NLR, PSA, CRP, and WBC as predictors of acute prostatitis. NLR is a simple, inexpensive inflammation parameter that correlates well with CRP levels.

Elevation of Serum Prostate-Specific Antigen Levels in Males With Pulmonary Embolism.

Hypoxemia is a clinical characteristic of pulmonary embolism (PE). Hypoxemia is associated with variations in serum prostate-specific antigen (PSA) levels. Thus, the present study aimed to determine serum PSA levels in patients with PE, which may be helpful in improving clinical evaluation in screening for prostate diseases in those with PE. Clinical data from 61 consecutive male patients with PE and 113 age-matched healthy male controls were retrospectively analyzed. The pulmonary artery obstruction index (PAOI) was used to evaluate the pulmonary embolic burden. Compared with healthy controls, serum total PSA (tPSA) levels were significantly increased (P = .003), and free PSA (fPSA)/tPSA ratio was significantly decreased in patients with PE (P < .001). There was no significantly difference in serum fPSA levels between patients with PE and healthy controls (P = .253). A significant positive association was observed between serum tPSA levels and PAOI in patients with PE (β = .270, P = .036). Multivariable linear regression analysis revealed that serum tPSA levels were independently associated with PAOI in patients with PE (β = .347, P = .003). Serum tPSA levels were higher in male patients with PE than those in healthy controls, but fPSA was not affected. These findings highlight that PE may elevate serum tPSA levels, and that measures of tPSA should be interpreted with caution in screening for prostate diseases in patients with PE.

68Ga-PSMA PET/CT-based multivariate model for highly accurate and noninvasive diagnosis of clinically significant prostate cancer in the PSA gray zone

BackgroundThe prostate-specific antigen (PSA) has been widely used in screening and early diagnosis of prostate cancer (PCa). However, in the PSA grey zone of 4–10 ng/ml, the sensitivity and specificity for diagnosing PCa are limited, resulting in considerable number of unnecessary and invasive prostate biopsies, which may lead to potential overdiagnosis and overtreatment. We aimed to predict clinically significant PCa (CSPCa) by combining the maximal standardized uptake value (SUVmax) based on 68Ga‑PSMA PET/CT and clinical indicators in men with gray zone PSA levels.Methods81 patients with suspected PCa based on increased serum total PSA (TPSA) levels of 4 − 10 ng/mL who underwent transrectal ultrasound/magnetic resonance imaging (MRI)/PET fusion-guided biopsy were enrolled. Among them, patients confirmed by histopathology were divided into the CSPCa group and the non-CSPCa group, and data on PSA concentration, prostate volume (PV), PSA density (PSAD), free PSA (FPSA)/TPSA, Prostate Imaging-Reporting and Data System version 2.1 (PI-RADS v2.1) score, 68Ga-PSMA PET/CT imaging evaluation results and SUVmax were compared. Multivariate logistic regression analysis was performed to identify the independent predictors for CSPCa, thereby establishing a predictive model based on SUVmax that was evaluated by analyzing the receiver operating characteristic (ROC) curve and decision curve analysis.ResultsCompared to non-CSPCa, CSPCa patients had smaller PVs (median, 31.40 mL), lower FPSA/TPSA (median, 0.12), larger PSADs (median, 0.21 ng/mL2) and higher PI-RADS scores (P < 0.05). The prediction model comprising 68Ga-PSMA PET/CT maximal standardized uptake value, PV and FPSA/TPSA had the highest AUC of 0.927 compared with that of other predictors alone (AUCs of 0.585 for PSA, 0.652 for mpMRI and 0.850 for 68Ga-PSMA PET/CT). The diagnostic sensitivity and specificity of the prediction model were 86.21% and 86.54%, respectively.ConclusionGiven the low diagnostic accuracy of regular PSA tests, a new prediction model based on the 68Ga-PSMA PET/CT SUVmax, PV and FPSA/TPSA was developed and validated, and this model could provide a more satisfactory predictive accuracy for CSPCa. This study provides a noninvasive prediction model with high accuracy for the diagnosis of CSPCa in the PSA gray zone, thus may be better avoiding unnecessary biopsy procedures.

Possibilities of early diagnosis of localized prostate cancer in outpatient practice of a urologist at the regional level in the stavropol territory

Aim. To develop and implement an algorithm for early diagnosis of a localized form of prostate cancer based on the determination of the specificity of the prostate-specific antigen (PSA) marker in different age groups.Materials and methods. In the framework of a screening program for early detection of diseases of the urogenital system developed at the Stavropol Regional Clinical Specialized Uroandrological Center, middle-aged and elderly men were examined using the following characteristics: IPSS (International Prostate Symptom Score), serum PSA level, digital rectal exam, transrectal prostate ultrasound, urodynamic tests, as well as transrectal ultrasound-guided prostate biopsy in cases of elevated total PSA. The data (for 2010–2021) on the frequency of detection of localized prostate cancer depending on patient age (40–59 years, 60–69 years, ³70 years) and total PSA level were analyzed.Results. With an increase in total blood PSA &gt;4 ng/ml, there is a clear trend towards a decrease in the detection of benign prostatic hyperplasia and an increase in the detection of adenocarcinoma, which is confirmed by the data of histological examinations of biopsy specimens. In 81 % of cases, transrectal multifocal biopsy of the prostate gland (adenocarcinoma and prostatic intraepithelial neoplasia was detected) under transrectal ultrasound control is justified, including when PSA values are in the “gray zone”, which shows a rather high value of this method.Conclusion. Total serum PSA level is a readily available indicator for differential diagnosis of prostate diseases including detection of localized prostate cancer in out-patient conditions. The obtained data points at high specificity of this marker in men over 40 years old. Measurement of serum PSA level at the age of 40–49 years is necessary for early detection of oncological pathology. For total serum PSA level &gt;4 ng/mL, mandatory transrectal multifocal prostate biopsy is recommended at any age.

Urinary PCA3 a Superior Diagnostic Biomarker for Prostate Cancer among Ghanaian Men

Introduction Prostate cancer is one of the most commonly diagnosed cancers in men. Prostate-specific antigen (PSA) has been the biomarker of choice for screening and diagnosis of prostate cancer. However, inefficiencies exist with its diagnostic capabilities. This study thus evaluated the diagnostic and prognostic potential of urinary PCA3 as an alternative biomarker for prostate cancer in the Ghanaian population. Methods A hospital-based cross-sectional study was conducted at the Urology Department of the 37 Military Hospital, Accra, Ghana. A total of 237 participants aged 40 years and above with any form of suspected prostate disorder were recruited into the study after written informed consent was obtained. Total serum PSA levels was measured using the electrochemiluminescence method and transrectal ultrasound-guided systematic core needle biopsies were obtained from each study participant. Receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic accuracies of serum PSA, DRE, and PCA3 as diagnostic tools for prostate cancer. These three diagnostic tools were also evaluated in various combinations to ascertain the combinations with the best diagnostic accuracy. Results Prostate cancer was diagnosed in 26.6% of the participants. Benign prostate hyperplasia and prostatitis were diagnosed in 48.5% and 24.9% participants, respectively. DRE had a sensitivity of 93.7% and a specificity of 12.1%. PSA had a sensitivity of 92.1% and a specificity of 16.1%. PCA3 had a sensitivity of 57.1% and a specificity of 85.6% and showed a better accuracy (AUC = 83.0) compared to PSA (AUC = 60.0) and DRE (AUC = 65.0) as individual diagnostic tools. The combination of DRE+PCA3 score had the best diagnostic accuracy (AUC = 0.80) with a sensitivity and specificity of 60.3% and 80.5%, respectively. Conclusion The urinary PCA3 assay showed a better diagnostic performance compared to serum PSA and DRE. PCA3 as a stand-alone and in combination with DRE could be a suitable complimentary marker in diagnosis and management of prostate cancer.

Diagnostic nomogram based on intralesional and perilesional radiomics features and clinical factors of clinically significant prostate cancer

Previous studies on the value of radiomics for diagnosing clinically significant prostate cancer (csPCa) only utilized intralesional features. However, the role of tumor microenvironment is important in tumor generation and progression. The aim of this study is to build and validate a nomogram based on perilesional and intralesional radiomics features and clinical factors for csPCa. This is a retrospective study, which included 140 patients who underwent prostate magnetic resonance imaging (MRI). This study used 3.0T T2-weighted imaging, apparent diffusion coefficient maps (derived from diffusion-weighted images), and dynamic contrast-enhanced MRI. Region of interest (ROI)s were segmented by two radiologists. Intralesional and combined radiomics signatures were built based on radiomics features extracted from intralesional and the combination of radiomics features extracted from intralesional and perilesional volumes. Serum total prostate-specific antigen level and combined radiomics signature scores were used to construct a diagnostic nomogram. Intraclass correlation efficient analysis was used to test intra- and inter-rater agreement of radiomics features. Min-max scalar was used for normalization. One-way analysis of variance or the Mann-Whitney U-test was used for univariate analysis. Receiver operating characteristic curve analysis, accuracy, balanced accuracy, and F1-score were used to evaluate radiomics signatures and the nomogram. Also, the nomogram was evaluated using decision curve analysis in testing cohort. Delong test was used to compare area under the curves (AUCs). Statistical significance was set at p < 0.05. In testing cohort, AUC, accuracy, balanced accuracy, and F1-score of combined radiomics signature (0.94, 0.83, 0.80, and 0.87, respectively) were all higher than that of intralesional radiomics signature (0.90, 0.77, 0.74, and 0.83, respectively). The difference between AUCs was insignificant (p of 0.19). AUC, accuracy, balanced accuracy, and F1-score of the nomogram were 0.96, 0.94, 0.95, and 0.95, respectively. Nomogram was clinically useful when threshold probability of a patient is higher than 0.06. Perilesional radiomics features improved the discrimination ability of the radiomics signature. Diagnostic nomogram had a good performance. LEVEL OF EVIDENCE: 3. TECHNICAL EFFICACY STAGE: 2.

Effect of Antibiotic on Men with Raised Prostatic-Specific Antigen (4-10 ng/ml)

Background: The managing of raised Prostate-Specific Antigen (PSA) in a range of 4 to 10 ng/ml is still controversial among urologists. In addition to prostatic cancer, benign prostatic hyperplasia, and prostatitis is established to increase PSA. PSA reduction after antibiotic therapy might detect those patients in whom biopsy can be avoided or postponed. Objectives: To evaluate the effectiveness of a 6 weeks levofloxacin course on the serum total PSA level and PSA density (PSAD) in patients with PSA 4 -10 ng/ml and ordinary digital rectal examination and ultrasonography results. Materials and Methods: The study conducted at Al-Ramadi Teaching Hospital from February 2016 to December 2019. A total of 177 men with benign prostatic hyperplasia or lower urinary tract symptoms were with a normal digital rectal examination, chronic prostatitis (Expressed prostatic secretion was done before treatment), total PSA 4-10 ng/ml, and ultrasonography findings that did not reveal a hypoechoic lesion in the prostate will be included in this study. Serum PSA and PSAD were measured before, and after treatment with a 6 weeks course of levofloxacin. Results: The age of our 177 men was ranged from 40-80 years with a mean age of 56.52 years ± 7.253. The mean prostatic size was 49.5 ± 28.5 g (range, 23-150 g). In 89 (50.2%) patients of the 177 men, total PSA has normalized to less than 4 ng/ml after antibiotics treatment. In 56 patients of 89 men had a high level of PSAD. PSAD was normalized (less than 0.15 ng/ml/cm3) after treatment in 49 patients of the 56 patients. A significant reduction in total PSA and PSAD after treatment (p <0.05).

Serum total prostate-specific antigen (tPSA): correlation with diagnosis and grading of prostate cancer in core needle biopsy.

Aim To investigate the impact of pre-treatment serum total prostate-specific antigen (PSA) level on prevalence of prostate carcinoma detection in prostate core needle biopsy, and its correlation with established prognostic factors. Methods Prostate needle biopsy samples of 115 patients with available pre-treatment serum total PSA (tPSA) level were analysed. For all cases where morphology alone was insufficient, immunohistochemistry was performed using p63, CKHMW and AMACR antibody panel in order to confirm or exclude the existence of prostate carcinoma. Results Statistically significant positive correlation between serum total PSA values and prevalence of finding prostate carcinoma in needle biopsy specimens was found (p=0.011), as well as in the case when the patients were classified into groups according to tPSA levels (p=0.028). Serum total PSA values and levels (level groups) showed significant positive correlation with Gleason score (p=0.029 and p=0.036, respectively) and Grade Group of prostate carcinomas (p=0.044 and p=0.046, respectively). Sensitivity of the screening test by using 4 ng/mL as cut off value for tPSA was 94.12% (CI: 80.32-99.28%), specificity 8.64% (CI: 3.55-17.00%), positive predictive value 30.19% (CI: 21.65-39.87%) and negative predictive value 77.78% (CI: 39.99-97.19%). Conclusion The increase of serum tPSA value increases the likelihood of finding prostate cancer on needle biopsy specimens. Due to such findings and its positive correlation with a grade of prostate cancer, our study indicates that tPSA can still be considered as a useful tool both in detecting and predicting aggressiveness of prostate cancer.

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.

PT107 - Circulating tumor cells may improve PSA ability to predict positive prostate biopsy in patients with total serum prostate-specific antigen levels of 4–10 ng/mL

PT107 - Circulating tumor cells may improve PSA ability to predict positive prostate biopsy in patients with total serum prostate-specific antigen levels of 4–10 ng/mL

Factors affecting complications of transrectal ultrasound-guided prostate biopsy: A cohort study with 403 patients in a single center

Aim: Prostate cancer is among the common cancer types in male population. Transrectal ultrasound (TRUS) guided prostate biopsy is considered the gold standard for diagnosis of prostate cancer. Complications in this tissue sampling method were analyzed in the present study.Methods: A descriptive study with retrospective design was planned. A total of 403 patients who had 12 core TRUS guided prostate biopsy for the first time in December 2016 -November 2018 period were evaluated. Age of the patients, digital rectal examination finding, prostate specific antigen (PSA) levels, prostate volumes and complications were analyzed.Results: Average age, serum total PSA level and prostate volume of patients were 63.2±8.53 years, 21.6±18.19 ng/mL and 65.63±20.19 cc, respectively. Genitourinary system infection was observed in 7.2% of the patients after the procedure. In terms of non-infection complications, 23.1% of patients had hematuria, 16.1% hematospermia and 2.2% rectal bleeding. On the other hand, 4.2% of the patients had vasovagal episodes and 0.7% had acute urinary retention. Of all patients, 8.9% were hospitalized due to observed complications.Conclusion: We conclude that TRUS-guided prostate biopsy is a reliable diagnostic tool with low complication rates in patients with prostate cancer pre-diagnosis.

Serum PSA levels in patients with prostate cancer and other 33 different types of diseases.

The prostate-specific antigen (PSA), a glycoprotein, is a clinically used biomarker for screen and diagnosis of prostate cancer. Most of PSA in blood circulation is protein-bound, and only a small fraction is present as free PSA. In general, the serum total PSA levels are <4ng/mL in healthy controls and significantly increased in certain prostate cancer patients. Currently, <0.25 in the ratio of free PSA to total PSA (F/T value) is used as an indicator of prostate cancer. The mRNA of PSA is mainly expressed in prostate, and its protein product is a protease present in seminal plasma for the liquefaction of seminal coagulum in normal physiology. The F/T value as a prostate cancer biomarker has been questioned for its benefit over harm caused by its high false-positive rate of diagnosis. Furthermore, the molecular basis of how PSA is getting into blood circulation from seminal plasma is largely unknown. In current study, a total of 24,692 clinical lab test results of serum F/T values from healthy controls and patients with 34 different types of diseases including different types of cancers and nonneoplasm illnesses during the past 5 years were collected and analyzed statistically. Our data showed that even though the prostate cancer patients had the lowest median serum F/T values, both significantly increased and decreased serum F/T values were associated with different types of human diseases, such as acute cerebral infarction, coronary heart disease, uremia, and nephrotic syndrome. The possible molecular mechanisms of serum PSA as disease biomarkers are discussed.

Is Serum Prostate-Specific Antigen a Reliable Prostate Cancer Marker in Liver Transplant Candidates.

In this study, we aimed to determine whether the prostate-specific antigen level is a reliable marker of prostate cancer in patients with hepatic insufficiency, based on evaluation of alterations in serum prostate-specific antigen levels after liver transplant in patients with hepatic insufficiency. Medical records of all patients who underwent liver transplant at our hospital between January 2003 and June 2017 were retrospectively reviewed. Male patients who were > 40 years old with available pre- and posttransplant serum total prostate-specific antigen levels were included in the study. Our study included 36 male patients with a mean age of 54.6 ± 5.3 years (range, 45-73 y) at the time of liver transplant. The mean pretransplant serum total prostate-specific antigen level was 0.75 ± 0.77 ng/mL, which was significantly lower than the mean posttransplant level of 1.29 ± 1.57 ng/mL (P < .05). The pretransplant serum total prostate-specific antigen level was measured a mean of 4.9 ± 5.4 months before liver transplant versus a mean 27.6 ± 16.3 months after transplant. Prostate-specific antigen velocity was 0.2 ng/mL/year. Biochemical tests of liver function, including the mean serum levels of bilirubin, international normalized ratio, and albumin, were normal after liver transplant at 1.37 ± 2.33 mg/dL, 1.22 ± 0.36, and 4.16 ± 0.69 g/dL, respectively. Serum prostate-specific antigen levels may decrease in patients with hepatic insufficiency/cirrhosis; therefore, a low serum prostate-specific antigen level may not be a reliable marker for excluding prostate cancer in such patients. Transplant surgeons and clinicians must be aware of this so that all male transplant candidates > 40 years old are evaluated via digital rectal examination, regardless of the serum prostate-specific antigen level.

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

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

Serum proPSA as a marker for reducing repeated prostate biopsy numbers

Abstract Introduction Prostate specific antigen (PSA) has a lower sensitivity and specifity range of 4–10 ng/mL. We aimed to investigate the effectiveness of pPSA in reducing number of prostate biopsies. Methods This study enrolled 80 patients aged 50 years or older whom had serum total PSA levels between 4 ng/dL and 10 ng/dL. Age, prostate volume, tPSA, fPSA, pPSA, PSA%, pPSA%, t/pPSA, f/pPSA, p/fPSA, p/tPSA, f/p/tPSA, p/f/tPSA, PSAD, fPSA/PSAD, pPSA/PSAD, (Prostate Health Index) PHI, (t/f/pPSA)/tPSA, and PHI2 (New Prostate Health Index) biopsy results were compared between subjects BPH and PCa. Results Out of 80 subjects, 23 (29%) had PCa and 57 (71%) had BPH. Prostate volume was 51.65 mL in PCa and 64.85 mL in non-PCa group (p&gt;0.05). The rate of PCa increased as prostate volume was reduced and age increased. fPSA, PSA%, p/f/tPSA, fPSA/PSAD values were significant in favor of respectively; BPH, BPH, PCa and BPH (p&lt;0.05). Discussion Using prostate health index (PHI) was beneficial for predicting PCa. In addition, using pPSA in formulas such as (PHI2) pPSA/(fPSA*√tPSA), p/f/tPSA, (t/f/pPSA)/tPSA may also be useful. This study suggests that the use of pPSA may have a role in reducing the number of prostate biopsies in differentiating PCa and BPH.

Expression change of serum total prostate specific antigen with age and its significance in differential diagnosis of prostate cancer

Objective To evaluate the changes of serum total prostate specific antigen (TPSA) with age and its significance in differential diagnosis of prostate cancer (PCa) and prostatic hyperplasia (BPH). Methods TPSA and free prostate specific antigen (FPSA) in 146 cases of PCa, 108 cases of BPH and 210 cases of healthy subjects were detected by electrochemiluminescence. Results There was a positive correlation between age and serum TPSA level (r = 0.265, P < 0.01). The levels of TPSA in PCa and BPH groups were (85.40±56.70) μg/L and (7.90±7.00) μg/L, and the difference was statistically significant (t = 8.310, P = 0.001); FPSA levels were (5.16±4.90) μg/L, (1.50±1.36) μg/L, and the difference was statistically significant (t = 3.152, P = 0.030). In patients with TPSA levels ranging from 4.0 to 20.0 μg/L (diagnostic gray zone), the levels of TPSA in PCa and BPH groups were (8.82±4.01) μg/L and (8.41±3.95) μg/L, and the difference had no statistical significance (t = 0.198, P = 0.256); The levels of FPSA were (1.18±0.91) μg/L and (2.32±1.20) μg/L, the ratio of FPSA/TPSA were 0.12±0.08 and 0.24±0.23, and the differences were statistically significant (t = 23.56, P = 0.020; t = 32.45, P = 0.006). When FPSA/TPSA ratio was 0.16, its sensitivity and specificity for PCa were 84.4 % and 79.8 %, respectively. Conclusions Serum TPSA levels vary with age, and 95 % of all age groups should be used as the medical criterion to improve the specificity and accuracy of PSA in diagnosing with PCa. The ratio of FPSA/TPSA has a significant clinical value in differential diagnosis of PCa and BPH in patients with TPSA in diagnostic gray zone. Key words: Prostate specific antigen; Reference value; Diagnostic grey zone; Diagnosis, differential

Prostate cancer detection in patients with total serum prostate-specific antigen levels of 4–10 ng/mL: Diagnostic efficacy of MicroRNA-141

Objective: The purpose of this small pilot study was to evaluate the utility of microRNA-141 (miR-141) as a biomarker for detecting prostate cancer (PCa) in patients with total serum prostate-specific antigen (PSA) levels of 4–10 ng/mL, which is referred to as the “gray zone.” Materials and Methods: Eleven PCa patients, 23 benign prostatic hyperplasia (BPH) patients with PSA levels of 4–10 ng/mL, and 16 healthy controls were enrolled in this study. Total RNA was extracted from serum samples, and the level of miR-141 was analyzed by quantitative reverse transcription polymerase chain reaction. Results: The circulating miR-141 level was significantly higher in PCa patients than in BPH patients and healthy controls (fold change [mean ± standard deviation], 0.528 ± 0.083 for PCa, 0.297 ± 0.038 for BPH, and 0.262 ± 0.025 for controls; P< 0.05). Receiver operating characteristic curve revealed that the serum miR-141 yielded an area under the curve of 0.751, with 72% sensitivity and 92% specificity in discriminating patients with PCa from BPH patients with total serum PSA levels in the gray zone. Conclusion: The present results indicate that miR-141 expression is significantly increased in the peripheral blood of patients with PCa compared with BPH patients and healthy individuals. We think that miR-141 may guide clinicians during the decision phase of patients with PCa and BPH in the PSA gray zone.

IMPLICATION OF PROSTATE SPECIFIC ANTIGEN IN BENIGN PROSTATIC HYPERPLASIA

Background: Prostate-specific antigen (PSA) is the prostatic tumour marker of choice. Because PSA is not prostate cancer specific and prostate cancer develops in man at an age when the prevalence of benign prostatic hyperplasia is high, several parameters have been developed and investigated to enhance the sensitivity and specificity of the PSA test. The parameters included are PSA density (serum PSA concentration divided by the size of the prostate gland), PSA velocity (change in serum PSA over time), age specific reference ranges for serum PSA, percent free PSA, Digital rectal examination. Aim and Objectives: The aim of this study is to find out the implication of prostate specific antigen in benign prostatic hyperplasia. Materials and Methods: In this research, a correlative study of total serum PSA with digital rectal examination, prostatic volume, Transabdominal Ultrasonography, urine analysis with culture and sensitivity and histopathological examination of the patients with prostatic hyperplasia was done in 100 patients. Here our exclusion criterion was the patients with carcinoma of prostate. PSA was estimated in fasting blood sample and was collected when patient is without Foleys catheter or with catheter (24 hours after catheterization). It was estimated by Ciba Corning Automated Chemiluminescence System (ACS) using both monoclonal and polyclonal antiPSA antibody titers. Results and conclusion: Age specific rise in Serum prostate specific antigen level was found. The prostatic volume was highly significant in correlation with Serum prostate specific antigen. Digital Rectal Examination when compared with other parameters was found not to be significant in predicting the prostatic disease. The Total Serum PSA level done in all the cases does not show significance and none of the patients had malignancy even with Serum PSA> 4ng/ml. When prostate specific antigen density was calculated and compared with biopsy report positively, it was significant and was helpful in predicting the prostatic diseases and prognosis. With this we conclude that clinical correlation with Digital Rectal Examination and Transabdominal Ultrasound is very much helpful in predicting malignancy than totally relying on Serum PSA. We found that PSA is neither organ specific chemical nor disease specific.

Free/Total Serum Prostate-Specific Antigen Ratio in Women with Colorectal Cancer Has Prognostic Significance.

The presence of prostate-specific antigen (PSA) in colon cancer tissues has been shown, but its clinical significance has not been known yet in colorectal cancer patients. We investigated the prognostic significance of percent free PSA value (free PSA/total PSA×100) in female patients with colorectal cancer. The serum concentrations of total and free PSA were measured by solid-phase two-site immunoradiometric assay in 184 patients. The cancer-specific survival (CSS) of patients with percent free PSA value ≥35 was significantly better compared to that of patients with percent free PSA value <35 (CSS rate was 82.9 and 55.5%, respectively; log-rank x2=8135, p=0.004). In multivariate Cox analysis, this percent free PSA threshold value had independent prognostic significance (relative risk 0.27, 95% confidence interval 0.11-0.64, p=0.003). Percent free PSA value, calculated by serum total and free PSA levels, has prognostic significance in women with colorectal cancer. The studies with larger patient series, utilizing ultrasensitive PSA assays whose lowest detection limit is lower, are required for a clearer understanding of this issue.

Steroid Hormone Receptors as Potential Mediators of the Clinical Effects of Dutasteride: A Prospective, Randomized, Double-Blind Study.

This study characterizes the clinical and morphofunctional effects of a 5α-reductase inhibitor on steroid hormone receptors in normal human prostate tissue, as potential mediators of the clinical effects of dutasteride. This work was a prospective, double-blind, and randomized study that evaluated 49 men aged between 45 and 70 years, with no alterations in a digital rectal examination and prostate-specific antigen measurements between 2.5 and 4.0 ng/mL. These patients underwent prostate biopsy guided by transretal ultrasound with prostate neoplasia being ruled out, and the patients were divided into two groups, with one group receiving dutasteride ( n = 25) and one group receiving a placebo ( n = 24). The patients were clinically assessed each quarter, and at the end of 12 months they underwent new laboratory tests, prostate rebiopsy, and histopathological, immunohistochemical and clinical analyses. The estrogen receptor-beta (ERβ) and androgen receptor immunoreactivities were higher, and the proliferation/apoptotic ratio was significantly lower with predominance of the apoptotic process, followed by a significant reduction in the prostate volume and the total serum prostate-specific antigen levels in the dutasteride group when compared with the placebo group, with a clear supremacy of ERβ. There were no significant variations in the serum estrogen and testosterone levels, in the body mass index, or in the ERα immunoreactivities in the dutasteride and placebo groups. The results demonstrated the importance of the ERβ pathway in the activation mechanisms of apoptosis, exerting a protective effect in the normal prostate, indicating that this receptor might be an important mediator of the clinical effects of dutasteride.