Relationship between serum prostate‐specific antigen and prostate volume in Korean men with benign prostatic hyperplasia: a multicentre study

Abstract

OBJECTIVES To evaluate the relationship between prostate specific antigen (PSA) and prostate volume (PV) in Korean men, as PV is a key predictor of both disease progression and response to medical therapy in patients with benign prostatic hyperplasia (BPH), and PSA has been suggested as a proxy marker to estimate the total PV, mainly in Caucasians. PATIENTS AND METHODS From 1999 to 2004, men aged 50–79 years with lower urinary tract symptoms (LUTS) and BPH were enrolled into this multicentre study. The analyses included 5716 patients presenting to 11 medical centres with LUTS (International Prostate Symptom Score >8, peak urinary flow rate <15 mL/s); they had a mean age of 64.3 years, mean baseline PV of 36.9 mL, and mean baseline PSA level of 2.2 ng/mL. Men with a baseline PSA of >10 ng/mL were excluded, to reduce the likelihood of including occult prostate cancer. A biopsy was taken in those with suspicious findings on a digital rectal examination or serum PSA level of >4 ng/mL, to exclude prostate cancer. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of serum PSA to predict threshold PV in men with BPH RESULTS The PV and serum PSA level had an age‐dependent log‐linear relationship, the strength of which increased with age. The ROC curve analysis showed that PSA had good predictive value for various prostate volume thresholds (30, 40 and 50 mL). CONCLUSIONS The PSA‐PV relationship in Korean men is similar to that in Caucasians, but Korean men have a slightly lower PSA level and a smaller PV than Caucasians. The approximate age‐specific criteria for detecting Korean men with a PV of >40 mL were a PSA level of >1.3 ng/mL, >1.7 ng/mL and >2.0 ng/mL for men with BPH in their sixth, seventh and eighth decade, respectively.

Serum prostate-specific antigen as a predictor of prostate volume and lower urinary tract symptoms in a community-based cohort: a large-scale Korean screening study

“…Second, a previous study has shown that Asian men typically have smaller prostate and a higher PSA level compared with men in Western populations. 12 One previous data from Asian have shown that PV and serum PSA have an age-dependent log-linear relationship, the strength of which increases with age. 12 The ROC AUC thresholds to detect PVs .30 ml, .40 ml and .50 ml were 0.755, 0.814 and 0.826, respectively, which are relatively high compared with our results.…”

“…12 One previous data from Asian have shown that PV and serum PSA have an age-dependent log-linear relationship, the strength of which increases with age. 12 The ROC AUC thresholds to detect PVs .30 ml, .40 ml and .50 ml were 0.755, 0.814 and 0.826, respectively, which are relatively high compared with our results. However, in that study, men who visited a hospital with complaints of troublesome LUTS were included, it had limitation not to show real situation for common men.…”

“…In general, the difference between the PSA levels in Caucasian and Asian men is due to factors such as obesity and prostate size, our results slightly differed with previous studies in Western countries. 7,12,19 However, this report was a very large-scale study in a country consisting of only one race, and it evaluated PSA, PV and the IPSS in the general population regardless of symptoms. Additionally, the PV cutoff was different from previous studies.…”

“…One Asian study evaluating the relationship between PSA and PV showed Asianspecific criteria for detecting PV by PSA level stratified by age. 12 Although theirs was a multicenter study, the subjects included in this study were limited to patients visiting the hospital with troublesome symptoms.…”

Serum prostate-specific antigen as a predictor of prostate volume in Korean men with lower urinary tract symptoms

“…In addition, Korean men are more likely to have a smaller prostate when older than are white men of the same age. 16 Generally, in BPH, both total PSA and free PSA are predomintantly expressed within the TZ. 17 Although the peripheral zone contains a significantly greater area density and absolute volume of epithelium than the TZ, the serum PSA level is most strongly correlated only with the volume of epithelium in the TZ.…”