Urinary prostate specific antigen: Is the clinical use likely?

Pejcic, T.; Hadži-Djokić, Jovan; Acimovic, M.; Topuzovic, C.; Milković, B.; Janjic, Aleksandar

doi:10.2298/aci0504069p

Cited by 8 publications

(7 citation statements)

References 22 publications

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“…The theory seems to be supported by facts, and many investigators have obtained similar evidence. 7,8,13,[16][17][18] Prostate cancer is the most frequent cancer in men and is the second highest cause of mortality by cancer for the male population. The diagnosis, however, requires an invasive investigation in many men.…”

Section: Discussionmentioning

confidence: 99%

Urinary PSA: a potential useful marker when serum PSA is between 2.5 ng/mL and 10 ng/mL

Bolduc

Lacombe

Naud

et al. 2013

CUAJ

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Urinary PSA: a potential useful marker when serum PSA is between 2.5 ng/mL and 10 ng/mL ORIGINAL RESEARCH Abstract Introduction: Our objective was to evaluate the usefulness of urinary prostate specific antigen (PSA) in the differential diagnosis of benign prostatic hyperplasia (BPH) and prostate cancer. Methods:We undertook a prospective study and obtained informed consent from 170 men. They provided blood samples to measure serum PSA and 50 mL of firstvoided urine to measure urinary PSA. Seventy-seven men were diagnosed with BPH; 42 patients had newly diagnosed prostate cancer; and 51 were selected as age-matched control subjects. Data were analyzed using Wilcoxon signed rank tests, receiver operating characteristic (ROC) curves and logistic regression. Results:Prostate volume was 35 cm 3 and 45 cm 3 (p < 0.05), serum PSA was 9.7 ng/mL and 4.5 ng/mL (p < 0.001) and PSA density was 0.28 and 0.11 (p < 0.01) for prostate cancer and BPH patients, respectively. Overall, urinary PSA was not significantly different, but PSA ratio (urinary:serum) was significantly different at 6.7 and 30.6 (p < 0.001) for prostate cancer and BPH patients, respectively. A subgroup with serum PSA between 2.5 ng/mL and 10.0 ng/mL was selected and urinary PSA was significant: 52.6 ng/mL (n = 29) and 123.2 ng/mL (n = 35) (p < 0.05) for prostate cancer and BPH patients, respectively. PSA ratios were also significant (p = 0.007). ROC curves identified a cutoff for urinary PSA at > 150 ng/mL, with a sensitivity of 92.5%. When comparing prostate cancer patients with age-matched control subjects, serum PSA, urinary PSA and PSA ratio were different (p = 0.004). Conclusion:Our study supports urinary PSA as a useful marker in the differential diagnosis of prostate cancer and BPH, especially when serum PSA is between 2.5 ng/mL and 10 ng/mL. Low urinary PSA and PSA ratios point toward prostate cancer. A urinary PSA threshold of > 150 ng/mL may be used to decrease the number of prostatic biopsies. IntroductionSerum prostatic specific antigen (PSA) has proven to be a generally reliable indicator in the diagnosis and management of prostate cancer. It has revolutionized the management and follow-up of prostate cancer since its clinical introduction in the late 1980s. Serum PSA remains the best single test for the detection of early prostate cancer, and multiple variations have been studied to improve its sensitivity and speci- either urinary tract infection or symptoms of prostatitis. Patients were consecutively recruited during a scheduled clinic visit either before a transrectal ultrasound (TRUS) and biopsies (minimum of 8 core biopsies) for abnormal serum PSA or digital rectal exam (or both); or patients who had an established diagnosis of prostate cancer were recruited for participation when they presented for preadmission before a scheduled radical prostatectomy.A total of 170 men gave an informed written consent and provided blood samples to measure serum PSA and bioavailable testosterone (normal range 2-14 nmol/L), which was analyzed in our labor...

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Section: Discussionmentioning

confidence: 99%

Urinary PSA: a potential useful marker when serum PSA is between 2.5 ng/mL and 10 ng/mL

Bolduc

Lacombe

Naud

et al. 2013

CUAJ

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“…The authors believe that subjects with PSA of 2.5-10.0 ng/mL and uPSA > 150 ng/mL, could be exempted from prostate biopsy, in the absence of suspicious lesions on DRE and TRUS. In some studies, it has been found that larger tumors had lower uPSA than smaller tumors, probably due to the obstruction of the drainage of secretions [74][75][76] .…”

Section: Determination Of Psa In the Urine In The Diagnosis Of Bphmentioning

confidence: 99%

Benign prostatic hyperplasia and prostate-specific antigen

et al. 2015

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Androgens and prostate functionTestosterone (T) and 5α-dihidrotestosterone (DHT) play a crucial role in the fetal prostate development. These androgens stimulate mesenchyme, while mesenchyme induces the proliferation of the epithelial buds from the urogenital sinus. This process, called "mesenchyme-epithelial interaction", starts in the 10th gestational week and continues in the adult age 1, 2 . Testosterone induces the development of the seminal vesicles and Wolffian ducts, while DHT induces the development of the prostate, penis and scrotum.Prostatic tissue is composed of stroma and epithelium. Prostatic stroma is composed of stromal cells (fibroblasts, endothelial capillary cells, lymph vessels and smooth muscle cells), neuroendocrine (NE) cells, neural cell axons, intercellular liquid and collagen fibers 3 . Prostatic epithelium is composed of secretory, basal, intermediary and NE cells. Secretory cells synthesize and secrete various proteins, like prostate specific antigen (PSA), prostatic acid phosphatase (PAP), androgen receptor (AR) and make the greatest part of the prostatic epithelium. It is believed that NE cells induce growth, differentiation, and secretory functions of the prostatic epithelium 4 .Numerous factors regulate prostatic growth: endocrine, neuroendocrine, paracrine, or growth factors (GF), autocrine and intracrine factors. However, the action of the endocrine factors is the best known. Testosterone is the most important serum androgen in the male, with the average serum concentration of 611 ± 186 ng/dL, while the average DHT serum concentration is 56 ± 20 ng/dL. However, the average concentration of active, free T is only 12.1 ± 3.7 ng/dL, while the rest is bound to the globulins and albumins. The major androgen in the prostatic tissue is DHT, with the average tissue concentration of 2.4-5.1 ng/g. The average tissue concentration of T is 3-5 times lower and measures 0.9 ng/g 5-7 .Only free T molecules can enter the prostatic cell, by diffusion. In the cytosol, one part of T molecules transforms into DHT. Both T and DHT bind to AR and form androgen-AR complexes. Subsequently, those complexes make pairs, entering the nucleus and bind to androgen-responsive elements (ARE) on DNA. After the information was transcripted from DNA to mRNA, mRNA leaves the nucleus and comes on ribosomes, where the information is translated into protein. Enzyme 5-alpha reductase (5αR) performs the conversion of T to DHT. There are two isoforms of 5αR: type 5αR-2 is dominant in the prostatic stroma and accessory genital tissues. Type 5αR-1 is present in the skin and prostate epithelium. Benign prostate hyperplasiaBenign prostate hyperplasia (BPH) denotes progressive prostatic enlargement, associated with the symptoms of impaired emptying of the urinary bladder and followed with gradual progression of the symptoms and complications. The most common BPH-related complications are chronic urinary infection, urinary bladder stones, chronic and acute urinary retention. The prevalence of BPH is very high: BPH is the fourth...

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“…This leads to increase in serum PSA. (19)(20)(21)(22)(23)(24) However, concomitant decrease in urinary PSA level occurs that is its level decreases in cancerous conditions than in benign conditions (though the actual urinary level remains higher than serum PSA).This has been potentially explained by an altered drainage of prostate secretions in prostatic urethra which leads to decreased excretion of total PSA and thereby increase in serum total PSA. (25) Our findings regarding levels of urinary fPSA in prostatic malignancies compared to benign states of prostate corroborates with Bolduc S et al (2007).…”

Section: Discussionmentioning

confidence: 99%