Relationship between Serum Prostate Specific Antigen and the Pattern of Inflammation in Both Benign and Malignant Prostatic Disease in Middle Eastern Men

Abstract

To determine the effect of prostatitis on serum prostate specific antigen in the diagnosis of prostate cancer in Middle Eastern men, H&E-stained sections of all consecutive prostate specimens were reviewed for diagnosis (malignant or benign) and pattern of inflammation. Inflammation was categorized into acute, active chronic and chronic inactive and graded semi-quantitatively according to previously published criteria. Results were correlated with serum PSA obtained from patients' records. Of 513 prostate specimens reviewed; 435 (84.8%) were benign and 78 (15.2%) were malignant. Chronic inactive prostatitis was present in 259 (204 benign, 55 malignant) and active chronic prostatitis in 221 (204 benign, 17 malignant). Acute prostatitis alone was not observed and prostatitis was absent in 33 (27 benign, 6 malignant). There was no significant difference in the prevalence of inactive chronic prostatitis between benign and malignant specimens (p < 0.071), but active chronic prostatitis was more prevalent in benign specimens (p < 0.001). Increasing serum PSA was observed for increasing grades of both inactive and active chronic prostatitis in both benign and malignant disease. Prostate cancer showed higher serum PSA levels than benign, at different cut-off points (4 ng/ml = p < 0.0001; 8 ng/ml = p < 0.0001; 12 ng/ml = p < 0.0001). However, significant numbers of patients with benign prostate biopsies presented with PSA above 12 ng/ml (82/260 = 32%). We conclude that active chronic prostatitis is common in Middle Eastern men with benign prostatic disease and a significant number of these present with very high PSA levels, some over 300 ng/ml.

Serum Prostate-Specific Antigen Levels in Middle Eastern Men with Subclinical Prostatitis

“…Parameters determined by microscopy included the presence of prostate inflammation, which was classified into: (1) active chronic prostatitis (periglandular inflammatory infiltrate consisting predominantly of chronic inflammatory cells, but with some disruption of glandular epithelium as well as neutrophilic and macrophage infiltrate) and (2) chronic inactive prostatitis (periglandular fibrosis with surrounding chronic inflammatory infiltrate and/or lymphoid aggregate replacing a completely destroyed gland) ( fig. 1 , 2 ), as reported previously [9,14,15] . The severity of prostatitis was also graded semiquantitatively [9] .…”

“…We have observed this in Middle Eastern men and reported a high prevalence of active chronic prostatitis associated with high levels of serum PSA [11] . We found levels of serum total PSA over 10 ng/ ml and often exceeding 50 ng/ml in at least 30% of men with benign prostate disease but no clinical prostatitis in our institution [9,11] . Others have commented on similar, often empiric findings and advocated a thorough study of serum PSA levels in benign prostate diseases [12][13][14] .…”

“…In particular, high serum PSA levels have been reported in men with BPH, but no accompanying clinical prostatitis [8,9] . Subclinical or histologic prostatitis is a common finding in prostate specimens especially in association with BPH [10] .…”

Effects of Chronic Chromate Exposure on Human Serum Prostate Specific Antigen: A Cross Sectional Study

“…Prostate cancer and BPH are both often accompanied with inflammation [23][24][25] which can cause serum PSA elevation 26) . The peripheral blood WBC count and classification analysis may indicate the existence of the inflammation 27) , particularly the neutrophils often indicate the presence of an acute infection.…”

Inflammatory mechanisms associated with prostatic inflammation and lower urinary tract symptoms

“…[5][6][7][8] However, while inflammation is an extremely common observation in prostatic biospecimens, ranging from 43% to 98% in the above studies, it has been more difficult to determine whether the inflammation arose as a normal biologic part of the aging process, or whether inflammation actually contributes to prostatic enlargement, development of LUTS, and/or development of acute urinary retention (AUR).…”