Comparative Analysis of the Role of Prostate Specific Antigen Parameters in Clinical Practice

Abstract

Introduction: Serum prostate specific antigen at the cutoff levels of 4 ng/ml has low specificity for prostate cancer. We evaluated various PSA parameters (i.e., total PSA density [tPSAD], free PSA density [fPSAD], the ratio of free to total PSA [f/t ratio], and age-specific PSA) in terms of cancer diagnosis and reducing the number of negative results for prostatic biopsies. Materials and Methods: A series of 305 patients was studied. Serum tPSA and fPSA levels were measured. Prostate volume was measured with transrectal ultrasound, and sextant biopsies were performed. The f/t ratio, tPSAD, and fPSAD were calculated. Sensitivity and specificity were calculated for age-specific PSA. Receiver operating characteristic curve analysis was used to analyze the diagnostic performance of these PSA parameters. A subpopulation of patients with serum PSA levels between 4 and 10 ng/ml also was analyzed with a specific view to reducing negative results of biopsies. The Mann-Whitney U test was used to analyze the difference in these parameters between patients with benign and malignant histologies. Results: There was significant difference in these PSA parameters between patients with benign and malignant histologies (p < 0.05). tPSAD had the largest area under the curve for total population as well as for patients with tPSA levels between 4 and 10 ng/ml. Although the f/t ratio had a larger area under the curve than did tPSA assay in patients with PSA levels between 4 and 10 ng/ml, the difference was not statistically significant. Using a tPSAD of 0.12 ng/ml/ml as the cutoff level of negative results of prostate biopsies could be reduced by 37% in patients with PSA levels between 4 and 10 ng/ml. Although the f/t ratio could reduce negative results of biopsies by 33.8% at the cutoff value of 0.26, 15.6% of cancers would be missed. Age-specific PSA could reduce 31% of negative prostatic biopsies, but 28% of cancers would be missed. Using combined tPSAD and the f/t ratio did not improve reductions of negative biopsy results. Conclusion: tPSA density has the highest sensitivity and specificity in differentiating benign from malignant prostates. By using tPSA density, negative results of prostate biopsies can be reduced by 37%, while missing only a small number of cancers.

Prognostic significance of prostate specific antigen in comparison with histological grade of prostatic adenocarcinoma: A Hospital based study.

“…Prostatic adenocarcinoma mean age is 68.88±6.49 and more common between 61to 80 years of age in this study. In our study prostatic adenocarcinoma mean age figure are comparable with finding from other studies which report the mean age of 69 years by Thompson IM et al, [7] mean age of 65 years by Lyn et al, [8] and mean age of 68 years by H A Mwakyoma et al . [9] In the present study BPH cases are 79.83% which is nearby comparable with Kshitij et al, [10] Jeven et al, [12] Arunchitale et al [13] and Janardan et al studies.…”

Correlation of levels of Prostate Specific Antigen with Histopathological findings in patient diagnosed with prostate adenocarcinoma: A study from Central India

“…The various studies done by Mwakyoma and Mabandi showed 5.3%, 61.1% and 33.6% cases had Gleason score of 2-4, 5-7 and 8-10 respectively; Divrik et al observed 9.7%, 76.7% and 13.6% cases having Gleason score of 2-4, 5-7 and 8-10 respectively. [16][17][18][19][20][21][22][23][24][25] The results for the cases with Gleason scoring between 8-10 i.e poorly differentiated tumours are comparable to other studies. Thus, the present study shows more number of cases with gleason's score 2-4.…”

“…In view of high degree of association of HGPIN with prostatic carcinoma, it is suggested that these HGPIN patients need close follow-up, observations and investigations to rule out existence of carcinoma, especially in the peripheral zone. [15][16][21] 38 ( [15][16][17][18][19][20][21][22][23][24] In the present study, 38/150 cases (25.3%) showing prostatic adenocarcinoma, Gleason score of 2-4 (well differentiated), 5-6 (moderately differentiated), 7(moderately to poorly differentiated), 8-10 (poorly differentiated) were noted in 39.4%, 21.0%, 8.0% and 31.6% cases respectively. The various studies done by Mwakyoma and Mabandi showed 5.3%, 61.1% and 33.6% cases had Gleason score of 2-4, 5-7 and 8-10 respectively; Divrik et al observed 9.7%, 76.7% and 13.6% cases having Gleason score of 2-4, 5-7 and 8-10 respectively.…”

Evaluation of expression of immunohistochemical markers high molecular weight cytokeratin (HMWCK) and alpha-methylacyl coa racemose (AMACR) in prostatic needle biopsies and transurethral resection of prostate (TURP) specimen – A one year observational study

“…In our study mean age of adenocarcinoma was 75.62 years which is comparable to previously done studies. [6][7][8][9][10] In studies done by Kumaresan et al 4 and Shah RB et al, 11 the incidence of BPH with suspicious focus ranged from 26 -46%; in our study we found an incidence of 30%. Premalignant lesions like LGPIN and HGPIN in the present study had an incidence of 13.3% and 10% respectively which is similar to studies done by Rekhi et al 12 (11.2%) and Kumaresan et al8 (14.2%).…”