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ORIGINAL ARTICLE
Year : 2017  |  Volume : 12  |  Issue : 4  |  Page : 246-252

Serum prostate-specific antigen as a tumor marker for its correlation with histopathological diagnosis of prostatomegaly


Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, Maharashtra, India

Correspondence Address:
Dr. Biswadeep Sarkar
Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_29_18

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Background: Prostatomegaly is common in men past fifth decade of life and has been the most common cause of symptoms associated with lower urinary tract obstruction. The emergence of prostate-specific antigen (PSA) has come to rescue of clinicians at screening the prostate cancer by its raised value in serum. The further research over the PSA brought out few new indices which are sensitive in screening and suggesting prostate cancer such as the ratio between free and bound PSA, PSA density (PSAD), and PSA velocity. Objectives: The objective of this study is (1) to study serum PSA level and PSAD at the differentiation of benign prostatic hyperplasia (BPH), prostatic intraepithelial neoplasia, and prostatic carcinoma (PCa) established at prostatic tissue diagnoses, (2) evaluation of the significance of total prostate-specific antigen (TPSA) level in the intermediate range of 4–10 ng/ml at assessment of benign versus malignant prostatomegaly at tissue diagnoses, and (3) to draw cutoff values of PSAD (0.15 vs. 0.18 ng/ml/cc) in suggesting benign versus malignant prostatomegaly at tissue diagnoses. Materials and Methods: Digital rectal examination was carried out in suspected clinical cases of prostatomegaly. One hundred and eight cases of prostatomegaly have undergone TPSA estimation prospectively by Vidas TPSA kit. PSAD was calculated as the ratio between TPSA and the volume of the prostate. The sample received for histopathological diagnoses were either sextant biopsy (25 specimens), transurethral resection of prostate (68 specimens), and prostatectomy (15 specimens). Results: TPSA was performed in total 108 patients of prostatomegaly, of which 35 (40.22%) cases had TPSA in the range of ≤4 ng/ml, 37 (34.25%) cases had TPSA in the range of 4.01–10 ng/ml, and 36 (33.33%) cases had TPSA in the range of >10 ng/ml. The mean PSAD cutoff of <0.18 ng/ml/cc had revealed 79 (90.80%) cases of BPH. The mean PSAD cutoff of ≥0.18 ng/ml/cc had revealed 8 (9.1%) cases of BPH, 19 (100%) cases of PCa and 2 (100%) cases of prostatic intraepithelial neoplasia (PIN). Final tissue diagnoses in total 108 cases were as follows: BPH – 87 (80.55%) cases, PIN – 2 (1.85%) cases, and prostatic adenocarcinoma – 19 (17.59%) cases. Conclusion: The TPSA value over 10 ng/ml and mean PSAD value over 0.15 or over 0.18 ng/ml/cc can be used as criteria for prostatic biopsy. The mean PSAD cutoff of over 0.18 ng/ml/cc works superiorly for the diagnoses of malignant prostatomegaly, selection of the cases for the prostatic biopsy and medical or surgical management of prostatomegaly.


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