Serum levels of prostate specific antigen, free PSA, [−2]proPSA, fPSA/tPSA ratio, Prostate Health Index, and glycosylation patterns of free PSA in patients with benign prostatic hyperplasia pharmacotherapy

Abstract

BackgroundThe medication used to treat benign prostate hyperplasia (BPH), a common condition in men over 50 years of age, can alter the levels of biomarkers used in prostate cancer detection. Commonly used medications for BPH include alpha‐blockers, 5‐alpha reductase inhibitors (5‐ARIs), and muscarinic antagonists. We studied the impact of these drugs on total prostate‐specific antigen (tPSA), free PSA (fPSA), [−2]proPSA, fPSA/tPSA ratio, and the Prostate Health Index (PHI), as well as novel potential biomarkers in the form of glycan composition of fPSA.Patients and MethodsSerum samples were collected from 564 males with BPH, with a mean age of 68.5 years. The samples were used to measure levels of tPSA, fPSA, and [−2]proPSA. The fPSA/tPSA and PHI were then calculated. The glycan composition of fPSA was analyzed using lectin‐based glycoprofiling. Pharmacotherapy data was collected from the patients' medical records.ResultsAlpha‐blocker monotherapy was associated with higher fPSA and fPSA/tPSA ratio, and decreased PHI. Levels of tPSA were not impacted. Alpha‐blocker and 5‐ARI dual therapy was associated with reduced levels of fPSA, [−2]proPSA, and PHI. Therapy combining alpha‐blockers and antimuscarinic agents did not significantly influence biomarker levels apart from an increase in a Maackia amurensis lectin‐recognized glycan originating in fPSA.ConclusionBPH pharmacotherapy notably affects prostate cancer biomarkers. Recognizing the impact of pharmacotherapy is crucial for achieving an accurate diagnosis of prostate cancer and for planning treatment.