PSA-based screening has always been one of the controversial topics among urological researchers. In spite of its benefit in detecting early prostate cancer, PSA-based screening may not only result in widespread overdiagnosis and overtreatment of an often indolent disease, which is life-threatening in only a minority of patients, but also subject participators to such complications as erectile dysfunction and incontinence. Besides, whether PSA-based screening can reduce prostate cancer specific mortality has received considerable attention. This review offers a comparative analysis of recent studies on PSA-based screening for prostate cancer.
Humans ; Male ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis

A major problem for the early diagnosis of prostate cancer is the lack of clinically useful tests for screening a preclinical and asymptomic population without resort to invasive diagnostic procedures. Recent studies have demonstrated the possibility to detect genetic alterations in plasma or serum DNA from patients with prostate cancer or other cancers. Quantification and molecular event are associated with advanced stages and circulating tumor cells. These results indicate a new approach to the early diagnosis and monitoring of prostate cancer by non-invasive screening procedures based on the analysis of genetic changes in plasma.
DNA ; blood ; Humans ; Male ; Prostatic Neoplasms ; blood ; diagnosis

OBJECTIVETo assess the clinical value of serum complexed prostate-specific antigen(cPSA) in the diagnosis of prostate cancer (PCa).

METHODSSerum samples were obtained from 110 men with untreated benign prostatic hyperplasia (BPH) and 78 men with untreated PCa. The levels of cPSA, total PSA (tPSA) were determined by autoimmunochemistry luminescence method.

RESULTSBoth cPSA and cPSA/tPSA ratio were significantly different between patients with PCa and BPH (P < 0.005), especially, in men with tPSA values between 4.0-10.0 micrograms/L (the diagnostic gray zone). When cPSA/tPSA > or = 0.78 was taken as the cut-off value conjugated with tPSA < or = 10.0 micrograms/L, the sensitivity, specificity, negative predictive value and positive predictive value were as high as 97.8%, 95.8%, 81.9% and 96.5%.

CONCLUSIONSWith the introduction of cPSA and cPSA/tPSA ratio, early diagnosis of PCa by the assessment of tPSA has been made more sensitive and reliable, especially when the tPSA is within the diagnostic gray zone.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatic Hyperplasia ; blood ; diagnosis ; Prostatic Neoplasms ; blood ; diagnosis

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

Pro-prostate-specific antigen (proPSA) is the precursor of PSA and a form of free PSA (fPSA). In recent years, a lot of studies have been done on proPSA, the roles of its related indexes in the diagnosis of prostate cancer, and the value of its clinical application. The correlated indexes of proPSA include proPSA, % pPSA, p2PSA, % p2PSA and prostate health index (PHI). They are more effective than total PSA (tPSA) and fPSA in the diagnosis of prostate cancer, especially % p2PSA and PHI, which may significantly increase our ability to detect and identify PCa and lower the rate of unnecessary biopsies. This article presents an overview on the advances in the studies of proPSA and the application of its related indexes in the diagnosis of prostate cancer.
Biopsy ; Enzyme Precursors ; blood ; Humans ; Male ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis

OBJECTIVETo analyze the clinical performance of free prostate-specific antigen (fPSA) detection by ECLIA method, and evaluate whether ECLIA is suitable for clinical use.

METHODS341 samples were collected and tested prostate-specific antibodies with CMIA and ECLIA methods. These samples contain: 97 samples with abnormal high PSA value tested by CMIA method, and 244 normal PSA samples. Use CMIA as the reference method, and detect fPSA, tPSA levels, and the ratio of fPSA/tPSA. Analyze the testing results with statistical methods.

RESULTSCompared with CMIA, correlation coefficent of ECLIA fPSA detection is 0.99; correlation coefficent of f/tPSA ratio detection is 0.96; the sensitivity, specificity of ECLIA f/tPSA ratio detection are 85.71%, 92.6% respectively, the agreement rate with ECLIA is 87.4%. No cross reaction with bilirubin, lipohemia, hemolysis, RF, CEA, AFP, CA125, CA153, CA199 were found in the tests.

CONCLUSIONThe ECLIA method for free prostate-specific antigen detection showed good clinical performance; and is suitable for clinical use.

Electrochemical Techniques ; methods ; Humans ; Male ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; blood ; diagnosis ; Sensitivity and Specificity

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

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

The precursor of prostate specific antigen (proPSA) are distinct molecular forms of free PSA in serum. proPSA is comprised of native proPSA as well as several truncated forms, in which [-2] proPSA and [-4] proPSA are more prostate cancer (PCa)-associated than [-7] proPSA and [-5] proPSA. Clinical studies have recently provided evidence that [-2] proPSA can significantly improve the detection of PCa, particularly in patients with total serum PSA values less than 4 microg/L. In this paper, the mechanism and characteristics of proPSA formation and impact of proPSA on the early detection of PCa are reviewed.
Early Diagnosis ; Humans ; Male ; Prostate-Specific Antigen ; blood ; chemistry ; Prostatic Neoplasms ; diagnosis ; Protein Precursors ; blood ; chemistry ; Sensitivity and Specificity