Significance of Serum Prostate Specific Antigen Levels in Evaluating Prostatic Lesions with Histopathological Correlation
Keywords:
benign prostatic hyperplasia, fPSA, tPSA, premalignant lesions, prostate cancer
Abstract
Background: Prostate cancer is one of the commonest forms of cancer among men. Serum prostate specific antigen (PSA) used in the diagnosis of prostate cancer is also elevated in other benign and non-malignant diseases of prostate. Objectives: The objectives of the study were to determine the relationship of serum f(PSA) and t(PSA), its correlation with histopathological findings and to assess the PSA cut off variable in various pathological conditions of prostate with clinical relevance. Materials and methods: This study included 141 patients admitted for transurethral resection of prostate and 141 control cases. fPSA was determined on blood samples by sandwich enzyme linked immunosorbent assay and total PSA by Enzyme Linked Fluroscent Assay method. The samples were processed and stained with haematoxylin and eosin. Results: The mean t(PSA) values for benign, premalignant and malignant lesions were 10.3 ng/ml, 20.36 ng/ml and 75.92 ng/ml respectively. The mean serum fPSA values for benign, premalignant and malignant lesions were 3.2 ng/ml, 9 ng/ml and 13.2 ng/ml respectively. The cut off value for tPSA was 12.25 ng/ml and that of fPSA was 9.4ng/ml. The p value(<0.0001) was highly significant in determining premalignant and malignant lesions. Conclusion: Total PSA is raised in premalignant, malignant, inflammatory and benign neoplastic lesions of prostate. In cases where the t(PSA) values are between four - ten ng/ml, f(PSA) is useful marker in cases of malignancies, which were confirmed on histopathology.References
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8. Mikolajczyk SD, Marks LS, Partin AW, Rittenhouse HG. Free prostate-specific antigen in serum is becoming more complex. Urology. 2002; 59:797.
9. Balk SP, Ko YJ, Bubley GJ. Biology of prostate-specific antigen. J Clin Oncol. 2003; 21:383.
10. Lilja H, Christensson A, Dahlen U, et al. Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem 1991;37:1618.
11. Christensson A, Laurell CB, Lilja H. Enzymatic activity of prostate-specific antigen and its reactions with extracellular serine proteinase inhibitors. Eur J Biochem 1990;194:755.
12. Christensson A, Bjork T, Nilsson O, et al. Serum prostate specific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol 1993;150:100.
13. Catalona WJ, Partin AW, Slawin KM et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998;279:1542.
14. Luderer AA, Chen YT, Soriano TF, et al. Measurement of the proportion of free to total prostate-specific antigen improves diagnostic performance of prostate-specific antigen in the diagnostic gray zone of total prostate-specific antigen. Urology 1995;46:187.
15. Lakhey M, Ghimire R, Shrestha R, Bhatta AD. Correlation of serum free prostate-specific antigen level with histological findings in patients with prostatic disease. Kathmandu Univ Med J (KUMJ). 2010 Apr-Jun;8(30):158-63.
16. McNeal J. Pathology of Benign Prostatic Hyperplasia. Insight into Etiology. In: Lepor H, Walsh PC (eds). The Urologic Clinics of North America, 17th edn. WB Saunders Company: Philadelphia, 1990, pp 477–486.
17. Kohnen PW, Drach GW. Pattern of infl ammation in prostatic hyMikolajczyk SD, Marks LS, Partin AW, Rittenhouse HG. Free prostate-specific antigen in serum is becoming more complex. Urology. 2002; 59:797. perplasia: a histologic and bacteriologic study. J Urol. 1979;121:755-60. 152
18. Blumenfeld W, Tucci S, Narayan P. Incidental lymphocytic prostatitis: selective involvement with nonmalignant glands. Am J Surg Pathol. 1992;16:975-81.
19. T. Malati, G. Rajani Kumari, P.V.L.N. Murthy Ch. Ram Reddy, B. Surya Prakash.Prostate Specific Antigen In Patients Of Benign Prostate Hypertrophy And Carcinoma Prostate. Indian Journal of Clinical Biochemistry 2006; 21 (1): 34-40.
20. Kehinde EO, Sheikh M, Mojimoniyi OA, Francis I, Anim JT, Nkansa-Dwamena D, Al-Awadi KA. High serum prostate-specific antigen levels in the absence of prostate cancer in Middle-Eastern men: the clinician's dilemma. BJU Int. 2003 May; 91(7):618-22.
21. Bostwick DG, Brawer MK. Prostatic intraepithelial neoplasia and early invasion in prostate cancer. Cancer. 1987;59:788–794.
22. Kim HL, Yang XJ. Prevalence of high-grade prostatic intraepithelial neoplasia and its relationship to serum prostate specific antigen. Int Braz J Urol. 2002;28:413–417.
23. Goswami AP, Rupala G, Goswami NN. Serum PSA level in Prostatic lesions with Histopathological correlation in Gujarat. NJIRM. 2011; 2(4):33-8.
24. Meigs JB, Barry MJ, Oesterling JE, Jacobsen SJ. Interpreting results of prostate-specific antigen testing for early detection of prostate cancer. J Gen Intern Med. 1996;11:505.
2. Oesterling, JE. Prostate-specific antigen: a critical assessment of the most useful tumour marker for adenocarcinoma of the prostate. J Urol 1991;145:907-23.
3. Chan DW, Booth RA, Diamansid EP. Tumor marker. In, Brutis CA, Ashwood ER, Bruns DE, editors. Teitz textbook of clinical chemistry and molecular diagnostics. 4th edition. New Delhi:Elsevier; 2006.p.2053-95. 133.
4. Oesterling JE, Jacobsen SJ, Chute CG et al. Serum prostatespecific antigen in a community-based population of healthy men. Establishment of age-specific reference ranges. JAMA. 2003; 270:860.
5. Stamey TA, Caldwell M, McNeal JE, et al. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol. 2004;172:1297–1301.
6. Thompson IM, Ankerst DP, Chi C, et al. Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA. 2005;294:66–70.
7. Schroder FH, Bangma CH, Roobol MJ. Is it necessary to detect all prostate cancers in men with serum PSA levels <3.0 ng/ml? A comparison of biopsy results of PCPT and outcome-related information from ERSPC. Eur Urol. 2008;53:901–908.
8. Mikolajczyk SD, Marks LS, Partin AW, Rittenhouse HG. Free prostate-specific antigen in serum is becoming more complex. Urology. 2002; 59:797.
9. Balk SP, Ko YJ, Bubley GJ. Biology of prostate-specific antigen. J Clin Oncol. 2003; 21:383.
10. Lilja H, Christensson A, Dahlen U, et al. Prostate-specific antigen in serum occurs predominantly in complex with alpha 1-antichymotrypsin. Clin Chem 1991;37:1618.
11. Christensson A, Laurell CB, Lilja H. Enzymatic activity of prostate-specific antigen and its reactions with extracellular serine proteinase inhibitors. Eur J Biochem 1990;194:755.
12. Christensson A, Bjork T, Nilsson O, et al. Serum prostate specific antigen complexed to alpha 1-antichymotrypsin as an indicator of prostate cancer. J Urol 1993;150:100.
13. Catalona WJ, Partin AW, Slawin KM et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: a prospective multicenter clinical trial. JAMA. 1998;279:1542.
14. Luderer AA, Chen YT, Soriano TF, et al. Measurement of the proportion of free to total prostate-specific antigen improves diagnostic performance of prostate-specific antigen in the diagnostic gray zone of total prostate-specific antigen. Urology 1995;46:187.
15. Lakhey M, Ghimire R, Shrestha R, Bhatta AD. Correlation of serum free prostate-specific antigen level with histological findings in patients with prostatic disease. Kathmandu Univ Med J (KUMJ). 2010 Apr-Jun;8(30):158-63.
16. McNeal J. Pathology of Benign Prostatic Hyperplasia. Insight into Etiology. In: Lepor H, Walsh PC (eds). The Urologic Clinics of North America, 17th edn. WB Saunders Company: Philadelphia, 1990, pp 477–486.
17. Kohnen PW, Drach GW. Pattern of infl ammation in prostatic hyMikolajczyk SD, Marks LS, Partin AW, Rittenhouse HG. Free prostate-specific antigen in serum is becoming more complex. Urology. 2002; 59:797. perplasia: a histologic and bacteriologic study. J Urol. 1979;121:755-60. 152
18. Blumenfeld W, Tucci S, Narayan P. Incidental lymphocytic prostatitis: selective involvement with nonmalignant glands. Am J Surg Pathol. 1992;16:975-81.
19. T. Malati, G. Rajani Kumari, P.V.L.N. Murthy Ch. Ram Reddy, B. Surya Prakash.Prostate Specific Antigen In Patients Of Benign Prostate Hypertrophy And Carcinoma Prostate. Indian Journal of Clinical Biochemistry 2006; 21 (1): 34-40.
20. Kehinde EO, Sheikh M, Mojimoniyi OA, Francis I, Anim JT, Nkansa-Dwamena D, Al-Awadi KA. High serum prostate-specific antigen levels in the absence of prostate cancer in Middle-Eastern men: the clinician's dilemma. BJU Int. 2003 May; 91(7):618-22.
21. Bostwick DG, Brawer MK. Prostatic intraepithelial neoplasia and early invasion in prostate cancer. Cancer. 1987;59:788–794.
22. Kim HL, Yang XJ. Prevalence of high-grade prostatic intraepithelial neoplasia and its relationship to serum prostate specific antigen. Int Braz J Urol. 2002;28:413–417.
23. Goswami AP, Rupala G, Goswami NN. Serum PSA level in Prostatic lesions with Histopathological correlation in Gujarat. NJIRM. 2011; 2(4):33-8.
24. Meigs JB, Barry MJ, Oesterling JE, Jacobsen SJ. Interpreting results of prostate-specific antigen testing for early detection of prostate cancer. J Gen Intern Med. 1996;11:505.
Published
2019-12-28
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