A Comparative Study of Prostatic Specific Antigen Density and Its Correlated Histopathology in the Diagnosis of Benign and Malignant Prostatic Diseases

Abstract

BACKGROUND: Carcinoma of prostate gland is the most common malignancy above 65 yrs of age in men. Most patients with early-stage Ca prostate are asymptomatic. The presence of symptoms often suggests locally advanced or metastatic disease. It is important to detect Ca prostate at an early stage so that mortality due to this malignancy can be minimized. The specific threshold for prostate-specific antigen (PSA) to delineate patients who are at the highest risk has been controversial. It is wiser to refine PSA by its derivative parameter like PSAD (PSA/Vol.) which can be used as a better diagnostic tool in early detection of Ca Prostate. KEYWORDS: Digital Rectal Examination (DRE), PSA, Transabdominal ultrasonography, PSA density, Histopathological examination, BPH, CaP. INTRODUCTION:Herophilus of Chalcedon in 300 B.C. was the first to use the term -prostate‖ because of organ's location-standing before urinary bladder.All elderly men will exhibit some enlargement of prostate accompanied by various symptoms of prostatism. The distress caused, demands relief and surgery can bring dramatic improvement in these senior patients. Before attempting surgical treatment it is worth investigating the patient to rule out malignancy.Benign prostatic hyperplasia (BPH) is a pathologic process that contributes to, but is not the sole cause of, lower urinary tract symptoms (LUTS) in aging men. Previously held ideas that the clinical symptoms of BPH (Prostatism) are simply due to a mass-related increase in urethral resistance are too simplistic. It is now clear that a significant portion of LUTS is due to age-related detrusor dysfunction and other conditions such as polyuria sleep disorders, and a variety of systemic medical conditions unrelated to the prostate-bladder unit.BPH is the most common benign tumour in men, and its incidence is age related. The prevalence of histological BPH in autopsy studies rises from approximately 20% in men aged 41-50, to 50% in men aged 51-60, and to >90% men older than 80. Although clinical evidence of disease occurs less commonly, symptoms of prostatic obstruction are also age related. At age 55, approximately 25% of men report obstructive voiding symptoms. At age 75, 50% of men complain of a decrease in the force and calibre of their urinary stream.Risk factors for the development of BPH are poorly understood. Some studies have suggested a genetic predisposition, and some have noted racial differences. Approximately 50% of men under the age of 60 who undergo surgery for BPH may have a heritable form of the disease. This form is most likely an autosomal dominant trait, and first-degree male relatives of such patients carry an increased relative risk ofapproximately fourfold.

Correlation Between Serum Prostatic Specific Antigen and Prostatic Volume in Benign Prostatic Hyperplasia

“…At age 55, 25% of men report obstructive voiding symptoms. At age 75, 50% of men complain of a decrease in force and caliber of 11 their urinary stream .…”