Adenocarcinoma ; blood ; diagnosis ; pathology ; Biopsy, Needle ; Humans ; Male ; Neoplasm Invasiveness ; Neoplasm Staging ; methods ; Prostate-Specific Antigen ; blood ; Prostatic Intraepithelial Neoplasia ; blood ; diagnosis ; pathology ; Prostatic Neoplasms ; blood ; diagnosis ; pathology

Prostatic intraepithelial neoplasia (PIN) refers to the cellular proliferations within prostatic ducts, ductules, and acini. PIN is divided into three grades, PIN 1, PIN 2 and PIN 3, PIN 1 is a low grade (LPIN); PIN 2 and PIN 3 are high grades (HPIN). Clinically, the term PIN is usually used to indicate HPIN. LPIN is not used as a separate pathological diagnostic entity. HPIN is widely regarded as the precancerous change of prostatic carcinoma. HPIN and prostatic carcinoma share many similarities in epidemiology, genetics, morphology, as well as in location and clinical features. And so they are two closely related entities. HPIN is pathologically diagnosed, and shows no specificity on digital rectal examination (DRE) and transrectal ultrasonography (TRUS). HPIN does not elevate serum prostatic specific antigen (PSA) concentration. HPIN with an elevation of serum PSA should be considered as the possible coexistence of HPIN and prostatic carcinoma. There has been no consensus on the management of HPIN, but it is widely held that simple HPIN detected by extended needle biopsy has no therapeutic implications, but should be followed up at regular intervals. If there are changes in PSA and/or DRE, repeated needle biopsy is imperative. The natural biological behaviour of HPIN is yet poorly understood. Currently, most urological experts do not recommend antiandrogen therapy to patients with simple HPIN.
Biopsy, Needle ; Humans ; Male ; Neoplasm Staging ; Prostate-Specific Antigen ; blood ; Prostatic Intraepithelial Neoplasia ; diagnosis ; pathology ; Prostatic Neoplasms ; diagnosis ; pathology

OBJECTIVETo evaluate the diagnostic usefulness of serum osteoprotegerin (OPG) in prostate cancer bone metastasis.

METHODSSerum osteoprotegerin were measured by ELISA assay in 30 healthy men, 30 patients with benign prostatic hyperplasia, 66 patients with prostate cancer including 36 without bone metastasis (30 with localized cancer, 6 with lymph node metastasis) and 30 with bone metastasis. The results associated with clinical data were calculated statistically.

RESULTSSerum osteoprotegerin were significantly increased in patients with bone metastasis compared with others (P<0.001). OPG level had a positive correlation with either prostate specific antigen (PSA) or Alkaline phosphatase (ALP) level (r=0.427, 0.277; P<0.001); and a positive correlation with either Gleason score or grade (r=0.427, 0.277; P<0.001). ROC analysis proved that OPG had better diagnostic accuracy than ALP for detecting bone metastasis in prostate cancer.

CONCLUSIONSerum osteoprotegerin could be used as a marker for diagnosis of bone metastasis in prostate cancer.

Biomarkers, Tumor ; blood ; Bone Neoplasms ; blood ; diagnosis ; secondary ; Humans ; Male ; Osteoprotegerin ; blood ; Prostatic Neoplasms ; pathology ; Sensitivity and Specificity

Antigens, Surface ; blood ; Diagnosis, Differential ; Glutamate Carboxypeptidase II ; blood ; Humans ; Male ; Neoplasm Staging ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; pathology ; Prostatic Neoplasms ; etiology ; metabolism ; pathology ; Racemases and Epimerases ; analysis

OBJECTIVETo determine the effect of obesity on prostate specific antigen (PSA) in men with benign prostatic hyperplasia (BPH) and develop a PSA-related parameter that can eliminate the effect of obesity.

METHODSWe reviewed the clinical data of 706 patients with BPH. Two PSA-related parameters, namely PSA mass (total circulating PSA protein) and PSA mass ratio (total circulation PSA protein per prostate volume), were calculated for all the patients and the association of BMI with PSA, PSA mass, and PSA mass ratio was assessed.

RESULTSA higher BMI was significantly associated with a greater plasma volume and prostate volume (P<0.05). Linear regression analysis revealed a greater adjusted R2 of BMI versus plasma volume than of BMI PSA (0.569 vs 0.027). PSA was positively associated with the prostate volume and negatively with BMI and plasma volume (P<0.05). PSA mass was positively associated with prostate volume (P<0.05) but was not associated with BMI or plasma volume (P>0.05). PSA mass ratio was not associated with prostate volume (P>0.05) but negatively associated with BMI and plasma volume. Plasma volume and prostate volume, PSA, and PSA mass ratio (P<0.05), but not PSA mass (P>0.05), differed significantly among normal-weight, overweight, and obese patients.

CONCLUSIONA higher BMI is associated with a greater plasma volume in BPH patients. In obese patients with BPH, a lower PSA concentration may result from hemodilution caused by a greater plasma volume, and PSA mass can eliminate the effect of obesity on PSA.

Body Mass Index ; Hemodilution ; Humans ; Male ; Obesity ; pathology ; Organ Size ; Overweight ; pathology ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; diagnosis ; Prostatic Neoplasms ; diagnosis

To assess whether the free-to-total prostate specific antigen (PSA) ratio (F/T PSA ratio) would enhance prostate cancer detection in Korean men with serum total PSA levels between 4 and 20 ng/ml. Methods: A total of 240 consecutive patients whose serum PSA levels were between 4 and 20 ng/ml were enrolled in this two-year study. All patients underwent ultrasound-guided transrectal biopsies of the prostate gland. The F/T PSA ratio was measured using the Roche immunoassay. Results: Of the 240 patients, 202 (84%) had benign histologies, while 38 (16%) had prostate cancer. The two patient groups were well matched for age. The mean F/T PSA ratio showed a statistically significant difference between the two groups: in the benign histology group it was 0.14 (0.04 - 0.37), and 0.10 (0.08 - 0.20) in the prostate cancer group (p< 0.05). Out of the 183 patients with a PSA level between 4-10ng/ml, the mean F/T PSA ratios were 0.14 and 0.11 in the benign histology (n=158) and prostate cancer groups (n=25), respectively (p< 0.05). From the 57 patients with a PSA level between 10 - 20 ng/ml, the mean F/T PSA ratios were 0.14 and 0.10 in the benign histology (n=44) and prostate cancer groups (n=13), respectively (p< 0.05). Overall, when the cut-off value of the F/T PSA ratio was 0.10, the sensitivity and specificity were 75.0% and 76.5%, while for the cut-off value of 0.15 they were 83.3% and 39.7% respectively. Conclusion: Our data demonstrated the usefulness of the free to total PSA ratio in distinguishing benign prostate disease and cancer disease, hence eliminating unnecessary biopsies. It is recommended that a cut-off value for the F/T PSA ratio of 0.10 be applied to Korean men which this is lower than the value used in Western countries.
Biopsy ; Humans ; Male ; Middle Aged ; Prostate/pathology ; Prostate-Specific Antigen/*blood ; Prostatic Neoplasms/*diagnosis ; ROC Curve

OBJECTIVETo assess the application value of diagnostic transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) patients with persistently abnormal serum PSA levels.

METHODSWe performed TURP for 71 BPH patients with the PSA level > 4 microg/L, and analyzed the Gleason scores and prognosis of the cases pathologically confirmed as prostate cancer (PCa). We conducted follow-up visits to all the patients, obtained the PSA levels and International Prostate Symptom scores (IPSS) at 6 and 12 months after TURP, analyzed their changes and assessed the value of TURP in the diagnosis and treatment of BPH with serum PSA abnormality.

RESULTSAmong the 40 patients with negative prostate biopsy and persistent serum PSA abnormality, 2 cases were diagnosed as Gleason score 6 prostatic adenocarcinoma by TURP biopsy, and 1 case as Gleason score 6 PCa by repeated biopsy. All the 3 patients underwent radical prostatectomies and were well recovered during the follow-up visits. Of the 31 patients who had refused biopsy, 9 cases were confirmed by postoperative pathology as Gleason score 7 -9 PCa, 1 treated by radical prostatectomy and the other 8 by endocrine therapy. Another 59 cases were pathologically diagnosed as BPH, of which, the serum PSA level was restored to normal in 56 and significantly reduced in the other 3, and IPSS was remarkably increased in 53 and improved in the other 6 following urethral soundings.

CONCLUSIONDiagnostic TURP can increase the early diagnosis rate of PCa, improve lower urinary tract symptoms (LUTS) and help to normalize the serum PSA level. Therefore, it can be chosen for those with persistent serum PSA abnormality, LUTS and negative prostate biopsy.

Adenocarcinoma ; diagnosis ; Biopsy ; Humans ; Lower Urinary Tract Symptoms ; diagnosis ; Male ; Prognosis ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; diagnosis ; Prostatic Neoplasms ; diagnosis ; Transurethral Resection of Prostate

Considering that antibiotic treatment may elevated the level of prostate-specific antigen (PSA) and hence limit the specificity of PSA test for prostate cancer, urologists use empiric antibiotic treatment for men with increased PSA levels. But it is controversial whether antibiotic treatment can exclude inflammation in the differential diagnosis of PSA elevation. Some researchers have found that antibiotic treatment can decrease inflammation-induced PSA elevation and help to reduce unnecessary biopsies, while others have reported that antibiotic treatment has no significant effect on the PSA level, and the lowered level of PSA following antibiotic treatment does not mean the decreased risk of prostate cancer. Further researches are needed to confirm the value of antibiotic treatment before biopsy.
Anti-Bacterial Agents ; therapeutic use ; Biomarkers, Tumor ; blood ; Biopsy ; Diagnosis, Differential ; Humans ; Inflammation ; metabolism ; pathology ; Male ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; pathology ; Prostatitis ; pathology

OBJECTIVESTo compare PSAD, PSAD-TZ, PSA, FPSA/TPSA detection used in diagnosis of prostatic hyperplasia(BPH) and prostatic cancer(PCa).

METHODSFourty-three cases of BPH and twenty cases of PCa with PSA < 20 micrograms/L were chosen, then compared PSA, PSAD, FPSA/TPSA, PSAD-TZ between BPH and PCa.

RESULTSThe mean PSA in BPH and PCa is (10.47 +/- 6.25) microgram/L and (13.92 +/- 3.20) microgram/L respectively with no statistic difference (P > 0.05). The mean PSAD in BPH and PCa is (0.15 +/- 0.12) microgram/L and (0.24 +/- 0.13) microgram/L respectively with statistic difference (P < 0.05). The mean FPSA/TPSA in BPH and PCa is (0.58 +/- 0.42) microgram/L and (0.26 +/- 0.17) microgram/L respectively with statistic difference (P < 0.05). The mean PSA-TZ in BPH and PCa is (0.26 +/- 0.22) and (0.51 +/- 0.28) respectively with obviously statistic difference (P < 0.01).

CONCLUSIONSThe results suggest PSAD, FPSA/TPSA, especially PSAD-TZ could be used to distinguish BPH and PCa.

Aged ; Aged, 80 and over ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; diagnosis ; Prostatic Neoplasms ; diagnosis

OBJECTIVETo investigate the possibility of differentiating prostate cancer (PCa) from benign prostatic disease by total prostate specific antigen (T-PSA) dynamic profiles following transrectal prostate biopsy, and to determine the cutoff value of the T-PSA ratio between pre- and post-biopsy.

METHODSA total of 36 men at the mean age of 69.89 years with increased serum PSA underwent prostate biopsy guided by transrectal ultrasound, followed by measurement of T-PSA at 10, 30, 60 and 90 min, plotting of T-PSA dynamic profiles and calculation of the pre- and post-biopsy T-PSA ratio at different time points. The patients were divided into a PCa and a non-PCa group according to the pathological results and compared for the difference in T-PSA ratios. The cutoff value of the pre- and post-biopsy T-PSA ratio was determined for the differentiation of PCa from benign prostatic diseases.

RESULTSThe post-biopsy T-PSA ratio was obviously higher in the non-PCa than in the PCa group (P < 0.05). With the ROC curve applied, the cutoff value of the T-PSA ratio was 1.5 and the best time for blood sampling was 30 minutes after the biopsy, with a 75% sensitivity and a 93% specificity.

CONCLUSIONEvaluation of the T-PSA ratio 30 minutes after biopsy might help screen the high-risk PCa population. Biopsy should be repeated for those with a lower T-PSA ratio in spite of initial benign results. The results are to be further supported by more prospective studies.

Aged ; Aged, 80 and over ; Biopsy, Needle ; methods ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Prostate ; pathology ; Prostate-Specific Antigen ; blood ; Prostatic Diseases ; blood ; diagnosis ; pathology ; Prostatic Neoplasms ; blood ; diagnosis ; pathology ; Sensitivity and Specificity