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

Abstract

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...

Can Levels of Urinary Matrix Metalloproteinases (Mmps) Act as an Alternative to Gleason’s Scoring in Prostatic Malignancies

“…(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). The difference in mean ranks of fPSA of cases (16.05) and controls (30.88) in the present study shows high statistical significance (U=43.50, p<0.001) ( Table: 1). MMP expression in prostate cancer was first described in 1991 by in situ hybridisation methods.…”

Benign prostatic hyperplasia and prostate-specific antigen

“…In a group of patients with PSA of 2.5-10.0 ng/mL, Bolduc et al 73 found a significant difference in mean uPSA in BPH (123.2 ng/mL) and PCa (52.6 ng/mL). With the uPSA threshold > 150 ng/mL, the sensitivity of the test was 92.5%.…”

Identification of Differentially Expressed Proteins in Direct Expressed Prostatic Secretions of Men with Organ-confined Versus Extracapsular Prostate Cancer

“…Efforts to adapt urine as a source of biomarkers for prostate cancer have been made using various approaches. For instance, DNA markers such as GSTP1 hypermethylation (55), RNA markers such as PCA3 (56), and protein markers such as ANXA3 (57), matrix metalloproteinases (58), and urinary versus serum PSA (59,60). In light of the clinical relevance of urine samples, we accessed EPS-urine for verification and potential future assay development of our candidate biomarkers.…”