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PubMed1995

Prostate-specific antigen density: correlation with histological diagnosis of prostate cancer, benign prostatic hyperplasia and prostatitis.

OBJECTIVE: To assess the additional value of prostate-specific antigen density in the diagnosis of prostate cancer in patients who undergo prostate biopsies. PATIENTS AND METHODS: The study comprised 376 patients with symptoms of prostatism who were undergoing prostate biopsy. Digital rectal examination (DRE) and transrectal ultrasonography (TRUS) were performed and the prostate specific antigen level (PSA) and density (PSAD) were determined for each patient. RESULTS: Both PSA and PSAD significantly differentiated (P < 0.001) between benign and malignant histology. Of the 376 patients, 91 (24%) had a PSA level in the intermediate range (4.0-10.0 ng/mL). In these patients PSAD was significantly better than PSA in differentiating between benign and malignant histology (P = 0.027 vs 0.316). With a PSAD limit of 0.15 ng/mL/cm3 in these patients, the sensitivity was 92% and the specificity was 54% for the diagnosis of prostate cancer. No patient with a positive biopsy had a PSAD < 0.11 ng/mL/cm3. No limiting value could be found for PSAD that combined both an acceptable sensitivity and specificity. Of the patients with a malignancy detected by the biopsy, 92% also had a suspect DRE. CONCLUSION: In patients with intermediate PSA levels, PSAD is of limited additional value when compared to DRE in correctly diagnosing prostate cancer. Acute prostatitis is also a possible cause of elevated PSA. Both PSA and PSAD had no additional value in differentiating between benign prostatic hyperplasia (BPH) and histologically proven extensive prostatitis.

Aged↗
PubMed2001

Can complexed prostate specific antigen and prostatic volume enhance prostate cancer detection in men with total prostate specific antigen between 2.5 and 4.0 ng./ml.

PURPOSE: We assessed whether complexed prostate specific antigen (PSA) and complexed PSA referenced variables would enhance prostate cancer detection in men with serum total PSA between 2.5 and 4.0 ng./ml. MATERIALS AND METHODS: Transition zone and total prostate gland volumes were determined in 151 men who underwent prostate biopsy using an 11 core biopsy strategy. In addition to measuring the Bayer section sign complexed PSA assay, we also calculated 2 computed complexed PSA values (Hybritech parallel total PSA--Hybritech free PSA and Bayer total PSA--Hybritech free PSA). We calculated 8 volume referenced variables using total and complexed PSA, and 2 computed complexed PSA values by dividing each value by the total prostate and transition zone volumes. RESULTS: Of the 151 patients 37 (24.5%) had cancer. In 10 of the 37 men with cancer (27%) a positive core was present in only 1 or more of the 5 alternate regions not sampled by conventional sextant biopsies. At 92% sensitivity a cutoff value of 2.3 ng./ml. for complexed and 31% for free-to-total PSA provided 42% and 11% specificity, respectively (p <0.001). In the 116 men with a total prostate volume of 30 cc or greater at 92% sensitivity the specificity of complexed PSA density (55%) and complexed PSA adjusted for transition zone volume (52%) were better than that of complexed (40%) and free-to-total (11%) PSA. In the 35 men with a total prostate volume of less than 30 cc at 92% sensitivity the specificity of complexed PSA (50%), complexed PSA density (55%) and complexed PSA adjusted for transition zone volume (55%) were significantly better than that of free-to-total PSA (8%, p <0.001). The area under the curve of complexed PSA was almost identical to that of the 2 computed complexed PSA calculations. CONCLUSIONS: A substantial proportion of men with total PSA values between 2.5 and 4.0 ng./ml. had prostate cancer. Complexed and computed complexed PSA were more specific than the free-to-total PSA ratio when total PSA was between 2.5 and 4.0 ng./ml. A 2.3 ng./ml. threshold for complexed and computed complexed PSA appears to stratify prostate biopsy results in men with total PSA between 2.5 and 4.0 ng./ml. The computed complexed PSA calculation appears to be equivalent to the complexed PSA serum assay for detecting cancer. Volume referenced complexed PSA performed better than complexed PSA in men with a total prostate volume of 30 cc or greater compared to men with a total prostate volume of less than 30 cc.

Adult↗
PubMed2003

[Prostate histopathology of NIH category IV prostatitis detected by sextant prostate needle biopsy from the patients with high prostatic specific antigen].

Asymptomatic prostatitis is classified as category IV in NIH classification of prostatitis syndrome (1999). No report concerning this category has been present. We investigated this category histopathologically and clinically, in order to clarify the histopathological distribution and its correlation to the clinical features, in this study. Among 785 patients who were suspected prostate cancer because of their high prostatic specific antigen (PSA) values and to have a sextant prostate needle biopsy was performed between January, 1996 and December, 2000, 88 patients (11.2%) were diagnosed as NIH category IV prostatitis (asymptomatic prostatitis). We observed all pathological specimens stained with Hematoxylin-Eosine, and classified them into subtypes according to the classification criteria for prostatitis defined by True et al. (1999). We also investigated the relationship between histopathological distribution and clinical features such as PSA values, PSA density, the incidence of pyuria or bacteriuria. In the histopathological study, grade distributions were 12.5% (11/88) in mild, 71.6% (63/88) in moderate, and 15.9% (14/88) in severe. Location distributions were 2.3% (2/88) in glandular, 68.2% (60/88) in periglandular, and 29.5% (26/88) in stromal. No relationship between these subtypes and clinical features was recognized statistically. However, 7 patients (7.95%) were diagnosed as prostate cancers, later. Pyuria was found in 29.1% (23/79). Bacteriuria was present in 14.3% (11/77). Isolated bacteria were 4 strains of Enterococcus faccalis, 2 strains of each of Pseudomonas aeruginosa and Staphylococcus aureus, and one strain of each of Escherichia coli, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter aerogenes, Staphylococcus haemolyticus, and Staphylococcus epidermidis. Gram positive rod, and Candida sp. No relationship between these subtypes and bacterial species was recognized. These results indicated that the incidence of NIII category IV prostatits was not low without correlation to any clinical features. However, we should pay attention to the presence of prostate cancer, because a small number of the patients were diagnosed as prostate cancer, later.

Aged↗
PubMed1997

The impact of systematic prostate biopsy on prostate cancer incidence in men with symptomatic benign prostatic hyperplasia undergoing transurethral resection of the prostate.

PURPOSE: We determined the impact of 1 or more systematic (4 to 6 cores) needle biopsies of the prostate on the incidence of prostate cancer in men undergoing transurethral resection of the prostate for symptomatic benign prostatic hyperplasia (BPH) with elevated serum prostate specific antigen (PSA) and/or suspicious digital rectal examination. MATERIALS AND METHODS: Records were reviewed retrospectively for 85 consecutive men 54 to 85 years old who underwent transurethral resection of the prostate for symptomatic BPH. Of the men 56 (66%) had at least 1 prior benign systematic prostate biopsy. RESULTS: Cancer was detected in the transurethral resection specimen in 5 of 29 men (17.2%) who had no prior prostatic biopsy and in 9 of 56 (16.1%) who had at least 1 prior benign biopsy. Among the latter group the probability of cancer being present in the transurethral resection specimen was not related to the number of prior biopsies, PSA concentration or PSA density. Of the cancers detected in men with at least 1 prior benign biopsy 89% were clinical stage T1b or greater. CONCLUSIONS: Clinically relevant prostate cancers may be detected in a significant proportion (more than 15%) of men undergoing transurethral resection of the prostate for symptomatic BPH despite prior screening with serum PSA, digital rectal examination and 1 or more systematic needle biopsies of the prostate.

Aged↗
PubMed1994

Prostate-specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ-confined prostatic cancer.

OBJECTIVE: To determine whether the ratio of PSA and prostate volume provides additional useful information for the discrimination of benign prostatic hyperplasia from prostatic carcinoma. PATIENTS AND METHODS: Since 1989, a prospective study has been in progress involving 229 patients (49 with locally confined prostatic carcinoma, 180 with benign prostatic hyperplasia) to establish whether the ratio of prostate-specific antigen (PSA) and prostate volume, determined by transrectal ultrasound (longitudinal x anterior-posterior x transverse diameter x 0.52), allows a better differentiation than the absolute PSA values. RESULTS: In this population of patients with prostatic disease, the positive predictive value for diagnosis of a prostatic carcinoma was 26% with an absolute PSA threshold value of 4.0 ng/ml, and 36% at a threshold value of 10 ng/ml. With a threshold value of the PSA/prostate volume ratio of 0.25 ng/(ml x cm3), the positive predictive value was 56% compared with 93% for a threshold value of 0.4 ng/(ml x cm3). CONCLUSION: The ratio PSA/prostate volume is a superior method for the diagnosis of prostatic carcinoma both with regard to its sensitivity and its specificity in patients with absolute PSA values in excess of 4 ng/ml.

Diagnosis, Differential↗
PubMed1993

[Immunohistochemical study of the prostatic tissues with monoclonal antibody against gamma-seminoprotein. Analyses of benign prostatic hyperplasia, metastatic foci from adenocarcinoma of the prostate and malignant neoplasms other than adenocarcinoma of the prostate].

The immunohistochemical specificity of the monoclonal antibody (43-21-1-1) against gamma-seminoprotein (gamma-Sm) in the prostatic tissues was evaluated by avidin-biotin peroxidase complex method. The normal tissues of various organs, other than male genitourinary organs already examined in the previous study, the brain, skin, spinal cord, tongue, esophagus, stomach, small intestine, rectum, trachea, lung, pleura, diaphragm, liver, spleen, pancreas, mesentery, kidney, lymph node, bone, bone marrow and striated muscle were examined for control study. The prostatic tissues obtained by surgery or biopsy, benign prostatic hyperplasia (BPH; 72) urethral polyp with prostatic-type epithelium (1), bone (3) or testicular (2) metastases from adenocarcinoma of the prostate and malignant neoplasms other than adenocarcinoma of the prostate, including primary small-cell carcinoma (1), secondary embryonal carcinoma (1) and secondary mucinous adenocarcinoma (1) of the prostate were then examined. Since all but 2 (97%) specimens of BPH were obtained by transurethral resection (TUR), which might cause non-specific staining due to electro-mechanical effects, the tissue of BPH obtained by suprapubic prostatectomy were examined simultaneously, serving as a control for immunostaining. The normal tissues of various organs were never stained positively for gamma-Sm. Positive reactions of gamma Sm with this monoclonal antibody were recognized in the cytoplasms of urethral polyp with prostatic-type epithelium, bone or testicular metastases from adenocarcinoma of the prostate. The malignant neoplasms other than adenocarcinoma of the prostate examined in this study, were never stained positively. There was obviously evidence of non-specific staining in the TUR tissues of BPH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1995

Prostate specific antigen in the expressed prostatic fluid of men with benign prostatic hyperplasia and prostate carcinoma.

PURPOSE: We tested the hypothesis that the histochemically demonstrated prostate specific antigen (PSA) content of prostate carcinoma cells does not necessarily reflect PSA production and secretion by evaluating expressed prostatic fluid. MATERIALS AND METHODS: Expressed prostatic fluid and serum from 152 men with clinical benign prostatic hypertrophy (BPH), 132 with histologically proved BPH and 46 with prostate carcinoma were analyzed with the Hybritech PSA assay. RESULTS: Expressed prostatic fluid PSA levels from carcinoma patients (median 1.70 mg./ml., mean 2.25) were significantly higher than in the histologically proved BPH group (median 1.28 mg./ml., mean 1.42, p < 0.05). CONCLUSIONS: PSA concentration is increased in the expressed prostatic fluid of prostates of men with carcinoma compared to those with histological BPH. This finding may be a functional manifestation of a field change or paracrine effects within the prostate.

Aged↗
PubMed2001

Comparison of human prostate specific glandular kallikrein 2 and prostate specific antigen gene expression in prostate with gene amplification and overexpression of prostate specific glandular kallikrein 2 in tumor tissue.

BACKGROUND: There is a need for specific markers that can indicate the different stages of prostate carcinoma. There is ongoing speculation concerning the value of prostate specific glandular kallikrein (hK2) in this regard. METHODS: The expression levels of both hK2 and human prostate specific antigen (hPSA) were compared at the mRNA and protein levels by using in situ hybridization and immunohistochemistry techniques in tissue specimens from patients with benign prostatic hyperplasia and malignant prostate carcinoma. The respective gene copy numbers were analyzed by a competitively differential polymerase chain reaction-based method. RESULTS: In situ hybridization revealed that hK2 was expressed at significantly higher levels in malignant prostate tissue compared with benign prostate tissue (P < 0.0005), whereas hPSA expression levels were the reverse (P = 0.06). In benign tissue, the mean level of hK2 mRNA was 82% of the respective value of hPSA (P < 0.003), whereas, in tumor tissue, the mean hK2 expression level was 21% higher than that of hPSA (P < 0.01). The results at the protein level supported the mRNA findings: hPSA expression was lower in malignant tissues compared with benign tissues (17 of 20 specimens), whereas an increase in hK2 expression was detected in 17 of 19 specimens. The authors report that the hK2 gene (hKLK2) was amplified in prostate carcinoma tissue, whereas the hPSA gene was not. There was a correlation between hPSA and hK2 mRNA levels in both benign tissue (correlation coefficient [r] = 0.735; P < 0.01) and malignant tissue (r = 0.767; P < 0.01). CONCLUSIONS: Gene amplification of hKLK2 may be one of the factors leading to higher expression of hK2 in prostate carcinoma. The correlation between hK2 and hPSA expression levels indicates coordinated expression of the genes in both normal and abnormal prostate gland. The results suggest the potential value of hK2 in the diagnosis of prostate carcinoma through mRNA analyses and gene amplification.

Biomarkers, Tumor↗
PubMed1986

Two-dimensional characterization of prostatic acid phosphatase, prostatic specific antigen and prostate binding protein in expressed prostatic fluid.

Specimens of pooled prostatic fluid, collected by rectal massage from men under 50 years of age with no apparent prostatic disorders, were subjected to two-dimensional gel electrophoresis to study the composition of its proteins. In a preliminary study, a total of 57 major protein groups were detected. In the present study, we attempted to identify, in the two-dimensional gels, those that are related to prostate-associated proteins, i.e., prostatic acid phosphatase (PAP), prostatic specific antigen (PSA), and prostate binding protein (PBP). Individual proteins were recognized by the procedure of Western Blot using specific antisera with peroxidase-antiperoxidase as the staining reagent. Each protein spot in the two-dimensional gel was expressed, along the abscissa, by its isoelectric point (pI) and, along the ordinate, by the molecular weight (MW). PAP consisted of a train of more than ten protein spots that occupied an area in the gel from pI 7.0, MW 45,000 to pI 6.0, MW 50,000. Four protein spots with a MW of 34,000 and a pI range of 8.2-8.8 were identified as PSA. PBP was observed as having three protein spots that were located at pI 5.6-6.6 with a single MW of 15,000. For PAP and PSA, additional protein spots with lower MWs also stained positively with the specific antisera, suggestive of the presence of degradative products of these proteins. Following the removal of the serum-related proteins by an extensive absorption with anti-human serum antibody by affinity chromatography, the prostatic fluid contained 27 major groups of non-serum proteins. These non-serum proteins in the prostatic fluid included PAP, PSA, PBP, and their related smaller molecular species. These results indicate that the prostatic fluid contains PAP, PSA, PBP and that their presence and the patterns of their distribution in the two-dimensional gels should be considered as the characteristic property of the prostatic secretions.

Acid Phosphatase↗
PubMed1995

Prostate specific antigen in a community-based sample of men without prostate cancer: correlations with prostate volume, age, body mass index, and symptoms of prostatism.

The correlation between both prostate specific antigen levels (PSA) and prostate specific antigen density (PSAD) and age, prostate volume parameters, body mass index, and the International Prostate Symptom Score (IPSS) were studied in a community-based population. A sample of 502 men aged 55 through 74 years was evaluated, excluding those with a serum PSA above 10 ng/ml, those with biopsy proven prostate cancer, and those who had previously undergone a prostate operation. PSA and PSAD did not correlate with the body mass index. Weak correlations were found between PSA and age (r = 0.25; P < 0.001), PSAD and age (r = 0.17; P < 0.001) and between PSA and the total prostate volume (r = 0.58; P < 0.001). PSA did not correlate independently with age after adjustment for volume (P = 0.22). The finding that PSAD correlates with age (r = 0.17; P < 0.001) is partly explained by the incomplete volume adjustment of PSAD which is proved by the positive correlation between PSAD and prostate volume (r = 0.26; P < 0.001). In the main target age-range for prostate cancer screening there is a poor basis for the use of age-specific reference values or volume adjustment for PSA levels in order to increase the clinical usefulness of this serum marker. Comparison of the results of the present study and studies conducted in others regions shows that there may be significant differences in PSA values per age stratum. Further studies are needed to clarify the reasons for these differences.

Aged↗
PubMed1993

[The quotient of prostate-specific antigen and prostate volume. Improved differentiation between benign prostatic hyperplasia and locally circumscribed prostate cancer].

Absolute serum prostate-specific antigen (PSA) values are of little help in the identification of locally confined prostatic cancer (PCA), because of a considerable overlap with the PSA values found in benign prostatic hyperplasia (BPH). Prostate gland volumes were estimated sonographically in 112 patients using the product of the three maximal diameters (longitudinal, anterior-posterior, transverse) and the factor 0.52. PSA was determined with a monoclonal immunoenzymetric assay (Tandem-E, Hybritech). The prostates were removed by either transvesical prostatectomy (for BPH) or radical retropubic prostatovesiculectomy (for PCA). In each case the diagnosis was verified by systematic histological examination. The ratio of serum PSA to estimated prostate volume did not exceed 0.4 ng/(ml x ml) in any of the 74 patients with BPH, whereas 23 of the 38 patients with PCA had a ratio above 0.4 ng/(ml x ml). The information provided by the PSA-prostate volume ratio is superior to absolute PSA values in preoperative differentiation between BPH and PCA. With a PSA-prostate volume ratio over 0.4 ng/(ml x ml) patients are at high risk for PCA and should be evaluated by prostate biopsy.

Adult↗
PubMed1997

The influence of prostate volume on the ratio of free to total prostate specific antigen in serum of patients with prostate carcinoma and benign prostate hyperplasia.

BACKGROUND: Determining the ratio of free to total prostate specific antigen (f-PSA to t-PSA, calculated as the percentage of f-PSA [f-PSA%]) in serum allow for a clearer distinction between patients with prostate carcinoma (PCa) and patients with benign prostate hyperplasia (BPH) than determining the level of t-PSA alone. To find influencing factors on f-PSA%, the authors investigated prostate volume, TNM classification, and tumor stage. METHODS: The authors measured f-PSA and t-PSA in 36 men with untreated PCa (tumor classification: T1, 2, 3pNO, MO), 44 patients with BPH, and 54 healthy controls. Prostate volume was determined by transrectal ultrasound. RESULTS: The median values of t-PSA and f-PSA% were 7.8 micrograms/L and 10.5% in PCa patients, 4.3 micrograms/L and 20.8% in patients with BPH, and 1.4 micrograms/L and 23.6% in the control group. Patients with PCa had a significantly lower proportion of f-PSA than BPH patients and healthy men. There was no correlation of f-PSA% to TNM stage or tumor grade. In PCa patients a significant positive correlation (correlation coefficient [r] = 0.51, P < 0.001) was found between f-PSA% and prostate volume, whereas there was no significant correlation in BPH patients (r = -0.27, P > 0.05). There was a significant difference in f-PSA% between PCa and BPH patients with prostate volumes smaller than 40 cm3 (9.0% vs. 21.6%, P < 0.01) but not between patients in these 2 groups with prostate volumes exceeding 40 cm3 (15.1% vs. 18.2%, P = 0.11). CONCLUSIONS: Determining the ratio of f-PSA to t-PSA to discriminate between PCa and BPH patients yields significant results only in men with a prostate volume of less than 40 cm3.

Aged↗
PubMedDate not supplied

[Effects of chronic bacterial prostatitis on changes in concentration and free and total prostatic specific antigen in the serum and urine from patients with benign prostatic hyperplasia and prostatic cancer].

A comprehensive urological examination was performed in 145 men with benign prostatic hyperplasia (BPH). Concentrations of total prostatic specific antigen (TPSA) suggested prostatic cancer (PC) in 38 patients while finger rectal examination and transrectal ultrasonic investigation gave no evidence for this diagnosis. All the patients have symptoms of chronic prostatitis (CP). All the patients with chronic bacterial prostatitis have undergone a course of antibacterial treatment after which the levels of TPSA and free prostatic specific antigen (FPSA) were evaluated. A polyposition biopsy of the prostate was also made. By its results two groups of patients were formed: 20 patients with BPH and CP (group 1) and 12 patients with CP and PC or prostatic ultraepithelial neoplasia. Low blood concentrations of TPSA high FPSA/TPSA, low urinary concentrations of TPSA and FPSA were registered after antibacterial and antiinflammatory treatment of CP combined with BPH. It is inferred that chronic bacterial prostatitis has a significant effect on PSA expression in BPH. This fact should be considered in interpretation of PSA values.

Adult↗
PubMed1991

Evaluation of prostate-specific antigen and prostatic acid phosphatase in untreated prostatic carcinoma and benign prostatic hyperplasia.

Prostate specific acid phosphatase (PAP) (Abbott, solid-phase enzyme immunoassay) and prostate specific antigen (PSA) (Hybritech, immunoradiometric assay) were determined in 162 newly diagnosed prostatic carcinoma patients, 187 patients with benign prostatic hyperplasia (BPH) and 127 controls. The upper limit of normal in controls for PAP was 2.2 micrograms/l and for PSA 5.0 micrograms/l. In the BPH group PAP was raised in 21%, for PSA in 41%. When the cut-off level of PSA was raised to 10.0 micrograms/l, 20% of BPH patients had an increased level. PSA was superior to PAP for the detection of prostatic cancer in all stages. Of the 162 patients with prostatic carcinoma, 88 had localised diseases and 74 had metastatic spread. PSA and PAP levels increased with each advancing clinical stage. PAP was elevated in 35% of the patients with cancer confined to the prostate. PSA in 69%. (PSA level 10.0 micrograms/l: 57%). In those patients with metastatic spread PAP was elevated in 77% compared with 96% for PSA. (PSA level 10.0 micrograms/l: 92%). The combined use of PSA and PAP does not give a greater accuracy in the screening of prostate cancer when compared with the sole use of PSA. PAP was elevated in only 4 patients when PSA was normal. In the BPH group there was no proven effect of micturition, frequency or residual urine on the SPA level. However, in this group infection may cause a rise in the PSA level.

Acid Phosphatase↗
PubMed1995

Comparison of prostate specific antigen, prostate specific membrane antigen, and LNCaP-based enzyme-linked immunosorbent assays in prostatic cancer patients and patients with benign prostatic enlargement.

Serum assays for prostate specific antigen (PSA; monoclonal), for prostate specific membrane antigen (PSM; Western blot), and a LNCaP/7E11.C5-based competitive enzyme-linked immunosorbent assay (ELISA) were evaluated in a small number of prostate cancer patients with localized or disseminated disease, and judged to be in clinical progression or remission based on National Prostate Cancer Project (NPCP) criteria. PSA values recognized the presence of clinical progression in localized disease (B1-C) and to a lesser degree disseminated disease (D1-D2). In contrast, to a limited degree the ELISA test recognized clinical progression mainly in disseminated disease and chiefly in stage D2. PSM values were elevated in both D1 and D2 but not in a linear fashion as observed with PSA. The ELISA and PSM results may be assessing a different clinical response to prostatic cancer than that recognized by PSA. This could reflect a developing clone of resistant prostatic cells as previously postulated. To further pursue this possibility a secondary generation of monoclonal antibodies to PSM is being developed. The ELISA levels for benign prostatic enlargement were not elevated above normal. In contrast both with PSA and PSM the assays reflected levels significantly above the normal range in benign prostatic hypertrophy (BPH).

Antibodies, Monoclonal↗
PubMed2005

[Comparison of value of free-to total prostate specific antigen, prostate specific antigen density and prostate specific antigen density of transition zone for diagnosis of prostate cancer in patients with a PSA level of 4.1-10 ng/ml].

PURPOSE: We evaluated the utility of free-to total PSA (F/T PSA) ratio, PSA density (PSAD) and PSA density of the transition zone (PSATZ) in diagnosis of prostate cancer with intermediate PSA level (4.1-10 ng/ml). PATIENTS AND METHODS: Between January 2000 and December 2003, systematic prostate biopsies were performed on 178 patients with intermediate PSA level. The clinical values of F/T PSA ratio, PSAD and PSATZ for the detection of prostate cancer were compared by using receiver operating characteristic (ROC) curves. RESULTS: Overall, 57 of the 178 (32%) patients had prostate carcinoma. The ROC curve analysis showed PSAD and PSATZ were superior to F/T PSA ratio in patients with intermediate PSA level. In patients with total prostate volume greater than 30 cm3, the area under the ROC curve for F/T PSA ratio was greater than that for PSAD and PSATZ. CONCLUSIONS: PSAD and PSATZ were more powerful predictors of prostate cancer than F/T PSA ratio in patients with intermediate PSA level. While F/T PSA ratio was effective for diagnosis of prostate cancer in prostate volume greater than 30 cm3.

Aged↗
PubMed2001

Serial prostate specific antigen, free-to-total prostate specific antigen ratio and complexed prostate specific antigen for the diagnosis of prostate cancer.

PURPOSE: The free-to-total prostate specific antigen (PSA) ratio and complexed PSA have been introduced as adjuncts to total PSA for prostate cancer screening. Little data exist on the use of these tests for serial PSA screening. We compared serial total PSA, the free-to-total PSA ratio and calculated complexed PSA in men diagnosed with prostate cancer and matched controls in a population based study. MATERIALS AND METHODS: We identified 90 men diagnosed with prostate cancer between 1988 and 1996 with at least 3 serial serum samples obtained at 2-year intervals who were participants in the beta-Carotene and Retinol Efficacy Trial for the prevention of lung cancer. Samples were available up to 10 years before diagnosis. A total of 90 age matched men from the same cohort without prostate carcinoma were identified as controls. Free and total PSA was measured by the Abbott AxSYM system. RESULTS: Baseline demographics of cases and controls were similar. At baseline and diagnosis the men with prostate cancer had higher total and complexed PSA, and a lower free-to-total PSA ratio than controls. Mean followup was 5.2 years in cases and 5.5 in controls. The yearly change in PSA parameters in cases versus controls was 20.7% versus 3.5% for total, -3.4% versus 0.2% for free-to-total and 21.5% versus 3.4% for complexed PSA (p <0.0001). At diagnosis PSA alone was estimated to perform with more than 90% specificity in our model. CONCLUSIONS: In this population based study total PSA was superior to the free-to-total PSA ratio for predicting the development of prostate cancer. While serial changes in free-to-total PSA ratios with time were statistically significantly different in men diagnosed with prostate cancer and controls, the magnitude of these serial changes were slight enough to render them clinically insignificant.

Adenocarcinoma↗
PubMed2001

[Predictive value of prostate specific antigen density in the detection of prostate cancer in patients with elevated prostate specific antigen levels and normal digital rectal findings or stage A prostate cancer].

We compared the usefulness of PSA and PSA density (PSAD) in diagnosing prostate cancer in 102 men who had a PSA value higher than 4.0 ng/ml and normal digital rectal examination and who had undergone transrectal ultrasonography-guided systematic sextant biopsies of the prostate between August 1996 and October 1999. In addition, for a group of 53 patients who underwent retropubic simple prostatectomy, PSA, PSAD and PSA transition zone (PSA-TZ) examination results for those with stage A prostate cancer were compared with the results for those with benign prostatic hyperplasia (BPH). Of the former 102 men, 20 (19.6%) had prostate cancer. There was no significant difference in mean PSA level between patients with negative and those with positive biopsy results (mean 9.3 and 11.8, respectively, p = 0.295), but the mean PSAD of patients with positive biopsy results was significantly higher than that of those with negative results (mean 0.55 and 0.29, respectively, p = 0.0007). Of the 53 men who underwent retropubic simple prostatectomy, 10 (18.9%) were diagnosed with stage A prostate cancer. There was no significant difference in mean PSA, PSAD and PSA-TZ examination results between patients with BPH and those with stage A prostate cancer. For all 102 patients and for 71 patients with PSA levels of 4.1-10.0 ng/ml, a PSAD cutoff value of 0.1 reduced the number of biopsies 15.7% (16 of 102 cases), and 22.5% (16 of 71 cases), respectively. These results suggest that by measurement of PSAD some patients with benign disease could be spared a biopsy which would have been performed based on PSA results alone.

Aged↗