Índice de Salud Prostática (phi) / Prostate Health Index (phi)

El antígeno específico de próstata (PSA, del inglés, Prostate Specific Antigen) es una glicoproteína producida por la próstata, y es el marcador tumoral de mayor uso. Sin embargo, su baja especificidad para diferenciar entre cáncer de próstata y otras alteraciones no malignas, como la hipertrofia benigna de la próstata (HBP) y la prostatitis aguda, limitan su utilidad diagnóstica

Prostate Specific Antigen (PSA) is a glycoprotein produced by the prostate and is the most widely used tumor marker. However, its low specificity to differentiate between prostate cancer and other non-malignant conditions, such as benign prostate hypertrophy (BPH) and acute prostatitis, limits its diagnostic utility

Antígeno prostático específico (PSA) relacionado al perfil antropométrico en pacientes del Hospital II Huamanga Carlos Tuppia García-Godos, EsSalud. Ayacucho

Objetivo: Determinar la asociación del nivel de antígeno prostático específico (PSA) plasmático y PSA masa según riesgo de padecer enfermedades prostáticas con el perfil antropométrico. Materiales y métodos: Estudio correlacional, de enfoque cuantitativo de dimensión transversal y retrospectiva. La muestra estuvo constituida por 156 historias clínicas de pacientes varones, con pruebas de PSA y datos antropométricos. Para el análisis de la relación de las variables se utilizó la prueba Rho de Spearman, con un nivel de confianza de 95 %. Resultados: La edad promedio de los pacientes fue 67,85±10,83 años y presentaron un valor medio de PSA de 3,57±7,30 ng/mL. El 9,60 % (15 pacientes) tuvo un riesgo bajo de padecer enfermedades prostáticas (PSA = 4,1-9,90 ng/mL); el 5,10 % (8 individuos) mostró riesgo intermedio (PSA= 10-19,90 ng/mL); y el 3, 80 %(6 pacientes) tuvo un riesgo alto (PSA ≥20 ng/mL). El promedio del índice de masa corporal (IMC) fue 26,37±3,81 kg/m2 : 85 pacientes (54,50 %) tenían sobrepeso; y 18 (11,50 %), obesidad. La media de PSA masa fue14,89±30,50 μg; la superficie corporal (SC) se calculó en 3,93± 2,72 m2; y el volumen plasmático fue 4,18± 0,21 L. Se evidenció una correlación positiva muy baja entre el PSA plasmático y la edad (rho = 0,184; p = 0,022), así como con entre la PSA masa y la edad (rho = 0,176; p = 0,028). Se obtuvo una asociación positiva moderada entre el PSA plasmático y la superficie corporal (SC) (rho = 0,456; p = 0,000); y entre el PSA masa y SC (rho = 0,463; p = 0,000). No se encontró relación entre el IMC y el PSA. Conclusiones: Se evidenció la asociación entre el valor de PSA plasmático y PSA masa con el perfil antropométrico, según el riesgo de padecer enfermedades prostáticas, que fue mayor con la superficie corporal y la edad.

Objective: To determine the association between plasma and mass prostate-specific antigen (PSA) levels and the anthropometric profile, taking into account the risk of prostate pathologies. Materials and methods: A correlational, quantitative, cross-sectional and retrospective study conducted with a sample of 156 medical records of male patients with PSA tests and anthropometric data. Spearman's Rho with a 95 % confidence level was used to analyze the relationship between the variables. Results: The average age of the patients was 67.85 ± 10.83 years and their mean PSA value was 3.57 ± 7.30 ng/mL. Fifteen (15) patients (9.60 %) had a low risk (PSA = 4.1 - 9.90 ng/mL), eight (5.10 %) a medium risk (PSA = 10 - 19.90 ng/mL) and six (3.80 %) a high risk (PSA ≥ 20 ng/mL) of developing prostate pathologies. The mean body mass index (BMI) was 26.37 ± 3.81 kg/m2: 85 patients (54.50 %) were overweight and 18 (11.50 %) were obese. The mean mass PSA was 14.89 ± 30.50 μg, the body surface area (BSA) was 3.93 ± 2.72 m2 and the plasma volume was 4.18 ± 0.21 L. A very low positive correlation was evidenced between plasma PSA and age (rho = 0.184; p = 0.022) and between mass PSA and age (rho = 0.176; p = 0.028). There was a moderate positive association between plasma PSA and BSA (rho = 0.456; p = 0.000) and between mass PSA and BSA (rho = 0.463; p = 0.000). No relationship was found between BMI and PSA. Conclusions: The association between plasma and mass PSA levels and the anthropometric profile was demonstrated, taking into account the risk of prostate pathologies, which increased with BSA and age.

Impacto de la obesidad en la agresividad del cáncer de próstata / Impact of obesity on the aggressiveness of prostate cancer / Impacto da obesidade na agressividade do câncer de próstata

RESUMEN El cáncer de próstata suele diagnosticarse tardíamente en obesos debido a que el exceso de tejido adiposo dificulta la detección del tumor al interferir en la exploración física (dificultad para realizar el tacto rectal) y en la confiabilidad de exámenes de diagnóstico complementarios como el Antígeno Prostático Específico (PSA, por sus siglas en inglés), retardando de esta forma la realización de la biopsia prostática. Con el objetivo de identificar la relación entre la obesidad y la agresividad del cáncer de próstata al momento de su diagnóstico, se realizó un estudio transversal, analítico en 136 pacientes diagnosticados con cáncer de próstata mediante biopsia transrectal, en el Hospital Provincial "Carlos Manuel de Céspedes", de Bayamo, Granma, Cuba, desde el 1ro de enero de 2018 hasta el 31 de diciembre de 2020. El análisis de asociación entre las variables (Índice de Masa Corporal [IMC], PSA, Suma de Gleason y Estadio Clínico) se realizó a través de la prueba de Tukey y la U de Mann-Whitney. La edad promedio de los pacientes fue de 66,1 años. No se encontró asociación significativa entre el PSA y el IMC (p > 0,05), sin embargo, el valor del PSA mostró una tendencia a disminuir en la medida que aumentó el IMC. La suma de Gleason y el Estadio Clínico mostraron una asociación directa con el IMC, (p<0,003) y (p=0.000) respectivamente. Los pacientes con sobrepeso y obesidad fueron más propensos a presentar valores de PSA más bajos y mayor Gleason, manifestándose en estos un mayor riesgo de cáncer de próstata agresivo al momento del diagnóstico.

ABSTRACT Prostate cancer is often diagnosed late in obese because excess adipose tissue makes it difficult to detect the tumor by interfering with physical examination (difficulty performing rectal touch) and the reliability of complementary diagnostic tests such as Psa, the delaying prostate biopsy. In order to identify the relationship between obesity and the aggressiveness of prostate cancer at the time of diagnosis, a cross-sectional, analytical study was conducted in 136 patients diagnosed with prostate cancer by transrectal biopsy, at the Provincial Hospital "Carlos Manuel de Céspedes", Bayamo, Granma, Cuba, from January 1, 2018 to December 31, 2020. The association analysis between the variables (Body Mass Index [BMI], PSA, Gleason Sum and Clinical Stage) was performed through the Mann-Whitney Tukey and U test. The average age of patients was 66.1 years. No significant association was found between PSA and BMI (p > 0.05), however, the psa value showed a tendency to decrease as BMI increased. The sum of Gleason and the Clinical Stadium showed a direct association with BMI, (p<0.003) and (p-0.000) respectively. Overweight and obese patients were more likely to develop lower PSA and higher Gleason values, with an increased risk of aggressive prostate cancer at the time of diagnosis.

RESUMO O câncer de próstata é frequentemente diagnosticado tardiamente em obesidade porque o excesso de tecido adiposo dificulta a detecção do tumor interferindo no exame físico (dificuldade em realizar o toque retal) e a confiabilidade de exames diagnósticos complementares como psa, a biópsia da próstata retardando. Como objetivo de identificar a relação entre obesidade e agressividade do câncer de próstata no momento do diagnóstico, foi realizado umestudo transversal e analítico em 136 pacientes diagnosticados comcâncer de próstata por biópsiatransretal, no Hospital Provincial "Carlos Manuel de Céspedes", bayamo, Granma, Cuba, de 1º de janeiro de 2018 a 31 de dezembro de 2020. A análise de associação entre as variáveis (Índice de Massa Corporal [IMC], PSA, Gleason Sum e Estágio Clínico) foi realizada através do teste Mann-WhitneyTukey e U. A idademédia dos pacientes foi de 66,1 anos. Nãofoi encontrada associação significativa entre PSA e IMC (p > 0,05), porém, o valor do PSA apresentou tendência a diminuir à medida que o IMC aumentou. A soma de Gleason e do Estádio Clínico mostrou associação direta com o IMC, (p<0.003) e (p-0,000), respectivamente. Pacientes com sobrepeso e obesidade foram mais propensos a desenvolver menores valores de PSA e Gleason mais elevados, commaior risco de câncer agressivo de próstata no momento do diagnóstico.

Evaluation of Prostate Specific Antigen Levels and Its Correlation with Histopathological Findings in a Tertiary Care Hospital in Bihar

Background: Diseases primarily inflicting prostate gland areinflammation, benign prostatic hyperplasia and cancer.Prostate specific antigen is a glycoprotein and is expressed byboth normal and neoplastic prostate tissue. It has been widelyused in the diagnosis and management of patients withprostatic cancer. Studies from various research workersdiscuss the proportion of prostatic disorder among Indianstates like Delhi, Mumbai, Bangalore, Chennai, Gujrat etc butthere is paucity of data from the rural areas. The present studywas conducted to find out the patterns of prevalence ofprostatic lesions among people of Rohtas district of Bihar andto correlate histology with respect to serum PSA levels inbiopsy specimens of men with prostatic disease.Materials and Methods: The study included 153 prostatictissue specimens (both transurethral resection of the prostateand prostatic biopsies) received in the Department ofPathology, over the period of 2-year from October 2017 toSeptember 2019. Relevant clinical data and serum PSA valuewas recorded, and Gleason’s microscopic grading was used tograde malignant lesions. Statistical analysis was performed inMicrosoft office excel 2007.Results: Mean age of presentation was 63 ± 10.56 years withmaximum incidence in the seventh decade of life. Onhistopathological examination, 52.9% had benign prostatichyperplasia, 35.9% had BPH with chronic prostatitis and 8.5%had adenocarcinoma. Other lesions encountered were highgrade prostate intraepithelial neoplasia (3 cases), sarcomatoidcarcinoma (1 case). Inflammatory pathology (55/153) wascommon at all PSA levels. Patients with PSA >20 ng/ml werewere more likely to show cancer. There exists a positivecorrelation between the increasing PSA levels and chances ofadenocarcinoma, the findings were statistically significant.Conclusion: Our study suggests that most frequentlyencountered prostatic lesion was BHP, commonly seen in theage group of 51-60 year The malignant lesions were commonamong the males of more than 60 years. Strong correlation ofprostate specific antigen levels of > 20.1 ng/ml with carcinomaprostate was seen.

Prostate disease correlation on demographics and clinical findings among national annual prostatic digital rectal examination campaign participants

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> National prostatic digital rectal examination (DRE) advocated by the Philippine Urological Association (PUA) started 2 decades ago in the advent of prostate specific antigen (PSA) screening. It is an effective campaign in promoting prostate health awareness among Filipinos. The aim of this research was to describe and correlate the demographics, clinical profile and prostatic physical findings examined by urologists in over 60 centers in the country.<br /><strong>METHODS:</strong> This study was an analytical cross-sectional study involving the participants of the 2013-2015 National DRE campaign. The data were retrieved from the PUA secretariat using a convenience-sampling method on completed forms. The data were correlated using a non-parametric measure of statistical dependence between two variables.<br /><strong>RESULTS:</strong> The total number of participants was continuously rising [n=978 (2013), n=2052 (2017) and n=2792 (2015)] having 60-70% newly diagnosed cases annually. Participants were mostly on their 6th decade of life, mostly employed, married and an educational attainment of secondary level. The most predominant symptom was nocturia followed by frequency, incomplete emptying and weak stream. The usual prostate size was between 21-30 grams mostly with doughy consistency, nodular and tender. The mean age of having clinically benign prostate enlargement was noted to be consistent at the age of 61 while that of a prostate cancer suspect ranged from 63-69 years old.<br /><strong>CONCLUSION:</strong> Filipinos have similar predominant signs and symptoms of prostate disease as compared to Malays, Chinese and Indians. Clinical findings of prostate diseases correlated well with age, prostate size and consistency.</p>

The application of CyberKnife stereotactic body radiotherapy in treatment of oligometastatic prostate cancer / 中华泌尿外科杂志

Objective To determine the effectiveness and safety of stereotactic body radiotherapy (SBRT)-CyberKnife for oligometastatic prostate cancer.Methods From May 2012 to February 2017,31 patients treated by CyberKnife were retrospectively reviewed,with a median age of 67 years(range 52 to 83 years),including 50 oligometastatic and 2 primary prostate cancer patients.The median PSA level was 8.4 ng/ml(range 0 to 300.0 ng/ml) and PSA test was performed every month.PSA progression-free survival (PSA-PFS),time to initiation of androgen deprivation therapy (ADT) and local control rate (LCR) were measured as the main outcomes.Results SBRT was well tolerated and were performed as planned in all patients.No SBRT related acute or late toxicities were observed.No bone fracture was observed in patients treated by bony targeted radiotherapy.The median follow-up after SBRT was 20.7.months (range 1.2-58.3 months).The median PSA-PFS was 5.3 months (range 0-58.3 months).1-year,2-year,and 4-year PSA-PFS was 52.0％,36.7％ and 36.7％ respe ctively.PSA level decrease was observed in 21 oligometastatic prostate cancer patients after SBRT,with median PSA-PFS of 12.3 months (range 1.2-58.3 months).PSA level increase was observed in 29 oligometastatic prostate cancer patients after SBRT.Six local recurrence were observed resulting in an actuarial 1-year,2-year and 3-year LCR of 90.4％,86.9％ and 82.6％,respectively.Twelve patients treated without ADT after SBRT,with median follow-up of 8.6 months (range 2.9-58.3 months) in this subgroup.Seven patients were added ADT after SBRT,with the median time from SBRT to initiation of ADT of 13.3 months (range 3.0-24.0 months) in this subgroup.Twelve patients were treated with ADT continuously after SBRT.Conclusions CyberKnife seems to be a safe and effective treatment with tolerated adverse events and good local control for patients with oligometastatic prostate cancer.

Prostate disease correlation on demographics and clinical findings among national annual prostatic digital rectal examination campaign participants

OBJECTIVE: National prostatic digital rectal examination (DRE) advocated by the Philippine Urological Association (PUA) started 2 decades ago in the advent of prostate specific antigen (PSA) screening. It is an effective campaign in promoting prostate health awareness among Filipinos. The aim of this research was to describe and correlate the demographics, clinical profile and prostatic physical findings examined by urologists in over 60 centers in the country.METHODS: This study was an analytical cross-sectional study involving the participants of the 2013-2015 National DRE campaign. The data were retrieved from the PUA secretariat using a convenience-sampling method on completed forms. The data were correlated using a non-parametric measure of statistical dependence between two variables.RESULTS: The total number of participants was continuously rising [n=978 (2013), n=2052 (2017) and n=2792 (2015)] having 60-70% newly diagnosed cases annually. Participants were mostly on their 6th decade of life, mostly employed, married and an educational attainment of secondary level. The most predominant symptom was nocturia followed by frequency, incomplete emptying and weak stream. The usual prostate size was between 21-30 grams mostly with doughy consistency, nodular and tender. The mean age of having clinically benign prostate enlargement was noted to be consistent at the age of 61 while that of a prostate cancer suspect ranged from 63-69 years old.CONCLUSION: Filipinos have similar predominant signs and symptoms of prostate disease as compared to Malays, Chinese and Indians. Clinical findings of prostate diseases correlated well with age, prostate size and consistency.

Pathology features of incidentally discovered prostatic cancer from radical cystectomy and its effects on the patients prognosis / 中华泌尿外科杂志

Objective To assess the incidence,clinic feature,pathological characteristics and prognosis of incidental prostate cancer from specimens via radical cystoprostatectomy (RCP) for muscleinvasive bladder cancer.The postoperative erectile function in patients with NVB operation are also to be evaluated.Methods Between Jan 2002 and Jan 2015,150 male patients with bladder cancer who underwent radical cystoprostatectomy in our center were included in this study.133 patients underwent open surgery and 17 cases underwent laparoscopic operation (13 patients underwent NVB operation).The average age of 150 patients was 63 years (ranging 41 to 83 years).The average tPSA was 3 ng/ml(ranging 0.2 to 7.8 ng/ml).The digital rectal examination was negative,CT results didnt exhibit the evident of abnormality in prostate.Results Overall,incidental prostate cancer was diagnosed in 11 male patients (7.3％).The pathological diagnosis are all prostatic adenocarcinoma.In those patients,the mean age was 65.5 years (ranging 42 to 82 years).The mean tPSA at the time of surgery was 2.6 ng/ml (0.3-4.0 ng/ml).There was no statistical significance of tPSA values in the incidental prostate cancer group and non risk group (2.6vs.3.2ng/ml)(P ＞ 0.05).The preoperative enhanced CT imaging showed normal prostate in 7 cases,prostate hyperplasia in 2 cases,prostate calcification in 1 cases and bladder cancer invasion into the prostate in 1 cases.9 cases of incidental prostate cancer are low risk grade (Gleason score ≤ 6,the clinical stage ≤T2).Among 11 cases,bladder cancer histologic type in 10 cases was transitional cell carcinoma and small cell carcinoma in 1 case.According to the TNM classification,4 cases were less than pT2 stage and 7 cases were more than pT3 stage.11 patients were followed up between 6 to 24 months (mean 10 months).All patient survived at the end of study without the treatment of castration.Among 13 cases accepted NVB operation,8 cases achieve the preoperative level of erectile function to achieve.Conclusions The rate of incidental prostate cancer from RCP specimens is low,Most patients have low risk level,and there was no statistical significance of tPSA values between the incidental prostate cancer group and non risk group.

Effects of Body Mass Index and Age on Prostate Specific Antigen: A Study on Men Attending a Tertiary Hospital in Ghana.

Background: Prostate specific antigen (PSA) is useful in the diagnosis of prostate adenocarcinoma. Aims: Our study sought to establish possible effect of age and BMI on serum PSA levels in Ghanaian men with genitourinary complaints. Methods: In this non-randomized, cross-sectional study, we recruited 202 men from the Genitourology and pathology departments of the Korle-Bu Teaching Hospital (KBTH) and MDS-Lancet Laboratories Ghana, between July 2011 and February 2012. Height and weight were measured and body mass index (BMI) calculated for each participant. Serum PSA levels were measured and prostate biopsies from each of the participants were examined histologically for diagnosis. Results: The mean PSA level was 200 ng/ml, mean age of 66.33±8.90 years, and a BMI of 23 kg/m2. The mean Gleason score of all participants was 3.38±3.58 years. There was a positive correlation between age and PSA levels (r=0.020; P=.78). A negative correlation was established between BMI and PSA (r=-0.068; P=.33). There was however a significant positive correlation (r=0.237; P=.001) between PSA levels and Gleason score. Linear regression analysis revealed no relationship between PSA and age (r=0.002; P=.98) and, PSA and BMI (r=-0.068, P=.36). Conclusion: Serum PSA levels correlate with age and BMI, however these factors do not have an effect on the levels of serum PSA at measurement. We suggest that PSA values be used in the context of the clinical scenario and other PSA altering factors.

Prostate Specific Antigen (PSA) Screening among Apparently Healthy Men of African Descent in Sokoto, North Western, Nigeria.

Background: Globally prostate cancer is the sixth leading cause of cancer-related death in men. Prostate Specific Antigen (PSA) is present in small amount in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer and other prostate-related disorders. The aim of this present study was to determine the PSA levels among healthy men of African descent resident in Sokoto, North Western Nigeria. Methods: Testing was carried out using the CTK Biotech PSA kit (CTK Biotech Inc, San Diego, USA). The Onsite PSA Rapid Test is a lateral flow chromatographic immunoassay for the qualitative detection of prostate specific antigen (PSA) in human serum or plasma at a cut-off level of 4.0 ng/mL. Result: We investigated the PSA levels in 106 consecutively recruited men of African descent with age range and mean age of 40-70 years and 44.75 ± 7.91 years respectively. We observed a PSA of > 4ng/mL among 7 (6.6%) of subjects studied. Men > 60 had the highest prevalence of raised PSA level (33.3%) compared to those younger men (p= 0.001). We observed a higher prevalence among farmers (11.1%) compared to business men, civil servants and students. Conclusion: In this present study we observed a high prevalence of PSA >4ng/mL and a positive and significant correlation between age and raised PSA levels among men in Sokoto, North Western Nigeria. We recommend an annual PSA blood test for men ≥ 40 years of age and that those with a PSA value > 4.0 ng/mL should be considered for further evaluation. There is also the need to build capacity among biomedical and medical staff in Nigeria to facilitate effective diagnosis of prostate cancer. There is also the need for increased prostate cancer awareness in the area to facilitate voluntary testing.

Importance of prostate-specific antigen (PSA) as a predictive factor for concordance between the Gleason scores of prostate biopsies and RADICAL prostatectomy specimens

OBJECTIVE: To evaluate the concordance between the Gleason scores of prostate biopsies and radical prostatectomy specimens, thereby highlighting the importance of the prostate-specific antigen (PSA) level as a predictive factor of concordance. METHODS: We retrospectively analyzed 253 radical prostatectomy cases performed between 2006 and 2011. The patients were divided into 4 groups for the data analysis and dichotomized according to the preoperative PSA, <10 ng/mL and ≥10 ng/mL. A p-score <0.05 was considered significant. RESULTS: The average patient age was 63.3±7.8 years. The median PSA level was 9.3±4.9 ng/mL. The overall concordance between the Gleason scores was 52%. Patients presented preoperative PSA levels <10 ng/mL in 153 of 235 cases (65%) and ≥10 ng/mL in 82 of 235 cases (35%). The Gleason scores were identical in 86 of 153 cases (56%) in the <10 ng/mL group and 36 of 82 (44%) cases in the ≥10 ng/mL group (p = 0.017). The biopsy underestimated the Gleason score in 45 (30%) patients in the <10 ng/mL group and 38 (46%) patients in the ≥10 ng/mL (p = 0.243). Specifically, the patients with Gleason 3 + 3 scores according to the biopsies demonstrated global concordance in 56 of 110 cases (51%). In this group, the patients with preoperative PSA levels <10 ng/dL had higher concordance than those with preoperative PSA levels ≥10 ng/dL (61% x 23%, p = 0.023), which resulted in 77% upgrading after surgery in those patients with PSA levels ≥10 ng/dl. CONCLUSION: The Gleason scores of needle prostate biopsies and those of the surgical specimens were concordant in approximately half of the global sample. The preoperative PSA level was a strong predictor of discrepancy and might improve the identification of those patients who tended to be upgraded after surgery, particularly ...

Role of Serum Total PSA (Prostate Specific Antigen) and Free to Total PSA Ratio in the Diagnosis of Carcinoma Prostate.

The objective of the study was to evaluate and compare the role of total and free/total ratio of serum prostate specific antigen level in diagnosing carcinoma prostate. A cross sectional study was conducted at the Department of Biochemistry, Dhaka Medical College (DMC) with collaboration of the Department of Urology, Dhaka Medical College Hospital (DMCH), Dhaka from July 2008 to June 2009. This study was carried out on 60 patients above 50 years of age who attended the Department of Urology, Dhaka Medical College Hospital, complaining of irritative or obstructive lower urinary tract symptoms (LUTS) suspected as clinically benign prostatic hyperplasia (BPH) or cancer prostate. It was aimed to assess the role of total and free/total ratio of serum PSA in diagnosis of BPH and carcinoma prostate with reference to histological diagnosis. All the cases were evaluated by history, physical examination including digital rectal examination, serum prostate specific antigen level, transabdominal/ trans-rectal ultra- sonogram. From all patients, blood sample were collected before digital rectal examination or any per urethral manipulation. Final diagnosis was obtained by histo-pathological examination, specimen being obtained by perrectal biopsy with biopsy-gun. Histopathological examination detected prostate cancer in 20 out of 60 patient and 17 of these Cap 20 have a total PSA 4 ng/ml and only 3 have total PSA 4 ng/ml. 18 of these 20 have free to total ratio 0.16 and 02 have f/t ratio 0.16. Among 60 patients, 40 patients were detected BPH on histopathological diagnosis. 20 of these BPH patient have tPSA 4 ng/ml and 20 of BPH have tPSA 4 ng/ml. 38 of 40 BPH patient have f/t ratio>0.16 and 2 of 40 patient are f/t ratio 0.16. Receiver operating characteristic analysis indicated a threshold f/t ratio 0.16 was optimum discriminatory level. The sensitivity of total serum PSA (at cut off value of>4 ng/ml) in correctly differentiating prostatic carcinoma of those who have the condition is 85%, while the specificity of the test in correctly detecting those who do not have the disease is 50%. The PPV is 45.9%, NPV is 87% and accuracy is 61.7%. The sensitivity of free/total serum PSA (at cut off value of 0.16 ng/ml) in correctly differentiating prostatic carcinoma from BPH is 90%, while the specificity of the test in correctly detecting those who do not have prostatic carcinoma is 95%. The PPV of the test is 90% and the NPV of the test is 95%. The overall accuracy of the test is 93.3%. This study showed significant difference of total and free/total ratio of serum prostate specific antigen (PSA) in differentiating benign prostatic hyperplasia (BPH) from carcinoma prostate. Receiver operating characteristic curves showed advantage for the f/t PSA ratio when compared with total PSA in detecting prostate cancer. From the study it may be concluded that total and f/t ratio of prostate specific antigen (PSA) is a useful marker in diagnosis of carcinoma prostate. Free/total ratio is more accurate than total PSA.

Study of Prostate Volume, Age, Serum Prostate Specific Antigen and Testosterone in Patients with Benign Prostate Hyperplasia with Lower Urinary Tract Symptoms / 대한남성과학회지

PURPOSE: The development of benign prostate hyperplasia(BPH) is attributed to aging and the presence of testis. We studied the relationships between serum prostate specific antigen(PSA), testosterone, age, andprostate volume in patients with BPH with lower urinary tract symptoms(LUTS). MATERIALS AND METHODS: From January 2003 to June 2004, 197 men with BPH with LUTS were evaluated for prostate volume with transrectal ultrasonography. From a serum sample collected between 9 and 11 AM, total PSA, free PSA, serum total testosterone, and free testosterone were measured. RESULTS: The average age was 61.0+/-11.3 years, and the average prostate volume was 34.2+/-16.7 ml. Age had a significant correlation with total PSA, free PSA, and prostate volume but an inverse correlation with free testosterone. Also, prostate volume showed a significant correlation with serum total PSA and free PSA but an inverse correlation with free testosterone. CONCLUSIONS: Age correlates positively with serum PSA and prostate volume but negatively with serum free testosterone. Prostate volume correlates positively with serum PSA but negatively with serum free testosterone.

Study of Prostate Volume, Age, Serum Prostate Specific Antigen and Testosterone in Patients with Benign Prostate Hyperplasia with Lower Urinary Tract Symptoms / 대한남성과학회지

PURPOSE: The development of benign prostate hyperplasia(BPH) is attributed to aging and the presence of testis. We studied the relationships between serum prostate specific antigen(PSA), testosterone, age, andprostate volume in patients with BPH with lower urinary tract symptoms(LUTS). MATERIALS AND METHODS: From January 2003 to June 2004, 197 men with BPH with LUTS were evaluated for prostate volume with transrectal ultrasonography. From a serum sample collected between 9 and 11 AM, total PSA, free PSA, serum total testosterone, and free testosterone were measured. RESULTS: The average age was 61.0+/-11.3 years, and the average prostate volume was 34.2+/-16.7 ml. Age had a significant correlation with total PSA, free PSA, and prostate volume but an inverse correlation with free testosterone. Also, prostate volume showed a significant correlation with serum total PSA and free PSA but an inverse correlation with free testosterone. CONCLUSIONS: Age correlates positively with serum PSA and prostate volume but negatively with serum free testosterone. Prostate volume correlates positively with serum PSA but negatively with serum free testosterone.

Evaluation of Prognosis Based on Changes of PSA Level Before and After ?-knife Treatment on Prostate Carcinoma / 医疗卫生装备

20ng/ml.The total three-year survival rate is 87%(33/35).Conclusion The effect and prognosis of ?-knife on prostate cancer treatment can be evaluated by the value of PSA before and after the treatment.

Cost-effectiveness Analysis of Prostate Cancer Screening

To determine the optimal strategy for prostate cancer screening, the cost-effectiveness of screening was analyzed using a medical decision model. One hundred thousand asymptomatic males between the ages of 40 and 69 were modeled with and without screening. The subjects were divided into three 10−year age groups. We used a 5−year survival rate as an effectiveness point and assumed after 5 year survival free from prostate cancer. We considered three potential programs: 1)screening with digital rectal examination(DRE), 2)screening with prostate specific antigen(PSA), and 3)screening with a combination of DRE and PSA. The study was analyzed from the payer’s perspective, and only direct medical costs were included. For each of the three age groups, PSA screening was more cost−effective than either DRE screening or a combination of DRE and PSA screening. The cost−effectiveness ratio for the combination of DRE and PSA screening was 1.1−2.3 times more expensive than that of PSA screening. If the compliance rate for work−up exams is 80%, the cost−effectiveness of prostate cancer screening is approximate to that of gastric cancer screening. In conclusion, PSA screening is the most cost−effective strategy for prostate cancer screening when compared with both DRE and the combination of DRE and PSA screening. But prostate cancer screening should be carefully conducted, taking the cost−effectiveness of the different strategies and target groups into consideration.

Pattern of Decrease of Prostate Specific Antigen after Radical Radiotherapy for the Prostate Cancer / 대한방사선종양학회지

PURPOSE: Prostate specific antigen (PSA) is a useful tumor marker, which is widely used as a diagnostic index and predictor of both treatment and follow-up result in prostate cancer. A prospective analysis was carried out to obtain the period of PSA normalization and the half life of PSA and to analyze the factors influencing the period of PSA normalization. The PSA level was checked before and serially after radical radiotherapy. MATERIALS AND METHODS: Twenty patients with clinically localized prostate cancer who underwent radical external beam radiotherapy were enrolled in this study. Accrual period was from April 1993 to May 1998. Median follow-up period was 26 months. Radiotherapy was given to whole pelvis followed by a boost to prostate. Dose range for the whole pelvis was from 45 Gy to 50 Gy and boost dose to prostate, from 14 Gy to 20 Gy. The post-irradiation PSA normal value was under 3.0 ng/ml. The physical examination and serum PSA level evaluation were performed at 3 month interval in the first one year, and then at every 4 to 6 months. RESULTS: PSA value was normalized in nineteen patients (95%) within 12 months. The mean period of PSA normalization was 5.3 (+/-2.7) months. The half life of PSA of the nonfailing patients was 2.1 (+/-0.9) month. The nadir PSA level of the nonfailing patients was 0.8 (+/-0.5) ng/ml. The period of PSA normalization had the positive correlation with pretreatment PSA level (R2=0.468). The nadir PSA level had no definite positive correlation with the pretreatment PSA level (R2=0.175). The half life of serum PSA level also had no definite correlation with pretreatment PSA level (R2=0.029). CONCLUSION: The PSA level was mostly normalized within 8 months (85%). If it has not normalized within 12 months, we should consider the residual disease in prostate or distant metastasis. In 2 patients, the PSA level increased 6 months or 20 months before clinical disease was detected. So the serum PSA level can be used as early diagnostic indicator of treatment failure.

Pathological study and PSA marking of 83 cases of prostatic carcinoma / 第三军医大学学报

The clinical and pathological materials of 83 cases of prostatic carcinoma (PC) were reviewed retrospectively and the tissue specimens of PC were marked with prostate-specific antigen (PSA). According to the criteria of Dhom's classification of prostatic carcinoma. 66 cases out of the 83 (79. 5%) were of the common variety of PC, 14 cases (10. 9%) were of the rare variety and 3 cases (3. 6%) could not be classified with Dhom's method. Among the 66 cases of common prostatic carcinoma, 41 cases (49. 4%) exhibited a pathological structure of u-riiforrn pattern and 25 cases (30. 1%) of pluriform pattern. Well-differentiated adenocarcinoma, cribriform carcinoma and carcinoid of the prostate were strongly positive to PSA marking; poorly-differentiated adenocarcinoma and almost all the prostatic carcinomas of the rare variety and with the structure of pluriform pattern were positive or weakly positive; undifferentiated solid carcinoma and small cell carcinoma were very weakly positive; and squamous cell carcinoma was negative. In addition, other methods for the pathological classification of prostatic carcinoma used currently at home and abroad were compared and discussed.