SIGNIFICANCE OF DETECTION OF FREE/TOTAL PSA RATIO AND OTHER BIOCHEMICAL PARAMETERS IN PATIENTS WITH BPH, CARCINOMA PROSTATE AND ITS CLINICOPATHOLOGIC CORRELATION
Keywords:benign prostatic hyperplasia (BPH), prostate cancer (PCa), prostate-specific antigen (PSA), free/total PSA
Background. Benign prostatic hyperplasia (BPH) can raise prostate-specific antigen (PSA) levels two to three times higher than the normal level. An increased PSA level does not indicate Prostate Cancer (PCa), but the higher the PSA level, the higher the chance of having PCa. Detection and treatment have been profoundly affected by the advent of Free/Total PSA ratio testing.
Objectives. The aim of the study was to estimate free, total PSA levels and its ratio for serum levels of calcium, acid phosphatase and alkaline phosphatase in patients with BPH and PCa; to correlate clinical, biochemical and histopathological findings in the above patients.
Methods. PSA levels were detected by Chemiluminescent assay; serum calcium – by Modified Arsenazo method; serum acid phosphatase – by Doumas et al method; and Alkaline phosphatase – by Lowry et al method.
Results. Present study found high levels of total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa rate. Free/Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were considerably higher in PCa as compared to BPH. Serum calcium levels did not show significant difference in control and study groups.
Conclusions. It was established that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in those without PCa. Therefore, in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary.
Objectives: The study was carried out with the following objectives: to estimate free, total PSA levels and calculate Free/Total PSA ratio in patients with BPH and Carcinoma Prostate, to study the serum levels of calcium, acid phosphates, and alkaline phosphatase in patients with BPH and PCa. and to correlate clinical, biochemical and histopathological findings in the above patients.
Methods. Free and total PSA levels were detected by Chemiluminescent assay; Serum Calcium was detected by Modified Arsenazo method. Serum acid phosphatase was detected by Doumas et al method and Alkaline phosphatase were detected by Lowry et al method
Results: Present study found high levels of Total PSA in BPH and PCa. Levels of free PSA were high in BPH as compared to PCa ate. Free /Total PSA ratio is reduced considerably in PCa as compared to BPH. Serum acid phosphatase and alkaline phosphatase were slightly raised in PCa as compared to BPH. Serum calcium levels did not show a significant difference in control and study groups.
Conclusion: We concluded that patients with PCa have a greater fraction of bound PSA and a lower percentage of free PSA than in men without PCa. There was a negative correlation found between the free/total PSA ratio and the histopathologic findings. The lower the ratio higher is the grade of malignancy. Therefore in clinical practice Free/Total PSA ratio helps clinicians to decide if a biopsy is necessary
Avci S, Onen E, Caglayan V, Kilic M, Sambel M, Oner S. Free prostate-specific antigen outperforms total prostate-specific antigen as a predictor of prostate volume in patients without prostate cancer. Arch Ital Urol Androl. 2020 Apr 6;92(1):1-6. doi: 10.4081/aiua.2020.1.1. PMID: 32255313.
Mao Q, Zheng X, Jia X, Wang Y, Qin J, Yang K, Bai Y, Xie L. Relationships between total/free prostate-specific antigen and prostate volume in Chinese men with biopsy-proven benign prostatic hyperplasia. Int Urol Nephrol. 2009 Dec;41(4):761-6. doi: 10.1007/s11255-009-9533-1. Epub 2009 Feb 18. PMID: 19224388.
Coban S, Doluoglu OG, Keles I, Demirci H, Turkoglu AR, Guzelsoy M, Karalar M, Demirbas M. Age and total and free prostate-specific antigen levels for predicting prostate volume in patients with benign prostatic hyperplasia. Aging Male. 2016 Jun;19(2):124-7. doi: 10.3109/13685538.2015.1131260. Epub 2016 Feb 12. PMID: 26872869.
Garvey B, Türkbey B, Truong H, Bernardo M, Periaswamy S, Choyke PL. Clinical value of prostate segmentation and volume determination on MRI in benign prostatic hyperplasia. Diagn Interv Radiol. 2014 May-Jun;20(3):229-33. doi: 10.5152/dir.2014. 13322. PMID: 24675166; PMCID: PMC4463345.
Grossfeld GD, Coakley FV. Benign prostatic hyperplasia: clinical overview and value of diagnostic imaging. Radiol Clin North Am. 2000 Jan;38(1):31-47. doi: 10.1016/s0033-8389(05)70148-2. PMID: 10664665.
Abbott L. et al. Acid phosphatase. Kaplan A et al. Clin Chem The C.V. Mosby Co. St Louis. Toronto. Princeton 1984; 1079-1083.
Young DS. Effects of drugs on Clinical Lab. Tests, 4th ed AACC Press, 1995.
Young DS. Effects of disease on Clinical Lab. Tests, 4th ed AACC 2001.
Allhoff EP, Proppe KH, Chapman CM, Lin CW, Prout GR Jr. Evaluation of prostate specific acid phosphatase and prostate specific antigen in identification of prostatic cancer. J Urol. 1983 Feb;129(2):315-8. doi: 10.1016/s0022-5347(17)52074-1. PMID: 6339742.
Bruzzese D, Mazzarella C, Ferro M, Perdonà S, Chiodini P, Perruolo G, Terracciano D. Prostate health index vs percent free prostate-specific antigen for prostate cancer detection in men with “gray” prostate-specific antigen levels at first biopsy: systematic review and meta-analysis. Transl Res. 2014 Dec; 164(6):444-51. doi: 10.1016/j.trsl.2014.06.006. Epub 2014 Jun 26. PMID: 25035153.
Woolf SH, Krist A. Shared decision making for prostate cancer screening: do patients or clinicians have a choice? Arch Intern Med 2009;169:1557-9.
Wolf AM, Wender RC, Etzioni RB, Thompson IM, D’Amico AV, Volk RJ, et al. American Cancer Society Prostate Cancer Advisory Committee. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 2010;60:70-98.
Barisiene M, Bakavicius A, Stanciute D, Jurkeviciene J, Zelvys A, Ulys A, Vitkus D, Jankevicius F. Prostate Health Index and Prostate Health Index Density as Diagnostic Tools for Improved Prostate Cancer Detection. Biomed Res Int. 2020 Jul 21;2020:9872146. doi: 10.1155/2020/9872146. PMID: 32775459; PMCID: PMC7396080.
Sasaki M, Ishidoya S, Ito A, Saito H, Yamada S, Mitsuzuka K, Kaiho Y, Shibuya D, Yamaguchi T, Arai Y. Low percentage of free prostate-specific antigen (PSA) is a strong predictor of later detection of prostate cancer among Japanese men with serum levels of total PSA of 4.0 ng/mL or less. Urology. 2014 Nov;84(5):1163-7. doi: 10.1016/j.urology.2014.04.055. Epub 2014 Oct 24. PMID: 25443923.
Huang, Yan MDa; Li, Zhen-Zhen MDa; Huang, Ya-Liang MDb; Song, Hong-Jun BDc; Wang, You-Juan MDa,* Value of free/total prostate-specific antigen (f/t PSA) ratios for prostate cancer detection in patients with total serum prostate-specific antigen between 4 and 10 ng/mL, Medicine: March 2018 - Volume 97 - Issue 13 - p e0249 doi: 10.1097/MD.0000000000010249
Lakhey M, Ghimire R, Shrestha R, Bhatta AD. Correlation of serum free prostate-specific antigen level with histological findings in patients with prostatic disease. Kathmandu Univ Med J (KUMJ). 2010 Apr-Jun;8(30):158-63. doi: 10.3126/kumj.v8i2.3550. PMID: 21209527.
Adamy A ,Yee DS,Matsushita K,et al .Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer.J Urol2011 Feb;185(2):477-82.
Muhittin Serdar,& Oguz, Ozkan & Olgun, Abdullah & Seçkin, Bedrettin & Ilgan, Seyfettin & haşimi, Adnan & Salih, Mustafa & Peker, Fuat & Kutluay, Turker. (2002). Diagnostic approach to prostate cancer using total prostate specific antigen-based parameters together. Annals of clinical and laboratory science. 32. 22-30.
Borros M. Arneth, Clinical Significance of Measuring Prostate-Specific Antigen, Laboratory Medicine, Volume 40, Issue 8, August 2009, Pages 487-491.
Ito K, Yamamoto T, Ohi M, Kurokawa K, Suzuki K, Yamanaka H. Free/total PSA ratio is a powerful predictor of future prostate cancer morbidity in men with initial PSA levels of 4.1 to 10.0 ng/mL. Urology. 2003 Apr;61(4):760-4. doi: 10.1016/s0090-4295(02)02427-5. PMID: 12670561.
Mione R, Barioli P, Barichello M, et al. Prostate Cancer Probability after Total PSA and Percent Free PSA Determination. Australian & New Zealand Journal of Psychiatry. 1998;13(2):331-339.
Manabu Kuriyama, Yukimichi Kawada, Yoichi Arai, Hiroshi Maeda, Shin Egawa, Ken Koshiba, Kyoichi Imai, Hidetoshi Yamanaka, Significance of Free to Total PSA Ratio in Men with Slightly Elevated Serum PSA Levels: A Cooperative Study, Japanese Journal of Clinical Oncology, Volume 28, Issue 11, November 1998, Pages 661–665.
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