Free and total prostate specific antigen in benign prostate hyperplasia and prostate cancer.

Saima Naz, Sarah Ahmad, Farkhanda Ghafoor, Nadeem Shafique Butt, M Waheed Akhtar, S Naz Ahmad, S., Ghafoor, F., Butt, N. S., & Akhtar, M. W.

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Abstract

Objective: To record the levels of PSA in the sera of prostate cancer (CaP) and benign prostatic hyperplasia (BPH) cases. Free PSA/total PSA as percentage was also calculated in order to evaluate its utility in differentially diagnosing BPH and CaP. Design: A cross-sectional, case control study. Place and Duration of Study: Shaikh Zayed Hospital and Mayo Hospital, Lahore from August 2002 to March 2003. Materials and Methods: A group of 108 male subjects, including one-third of each of biopsy-confirmed prostate cancer cases, BPH cases and asymptomatic controls of matching age were studied. PSA and Free PSA were determined by ELISA using commercially available assay kits. Results: Mean PSA was found to be highest in CaP cases (41.9 ± 38.7 ng/ml), lower in the BPH cases (13.5±10.5 ng/ml), while it was lowest in the control subjects (5.7 ± 4.4 ng/ml). Moreover, it was observed that a majority of the CaP cases had serum PSA >20 ng/ml, 50% of BPH cases had serum PSA in the ’gray zone’ (4.1-20 ng/ml), while majority of controls had serum PSA in the ’normal’ range (0 - 4 ng/ml). Using a free-PSA "cut-off" of 18% to differentiate between benign and malignant prostate enlargement, it was found that 80% of the CaP cases had F/T% <18, while 75% of the BPH cases had F/T%> 18. The percent free-PSA test to differentially diagnose BPH and CaP in the ’gray zone’ was found to have a sensitivity of 86% and a specificity of 94%. Conclusion: Using a cutoff of 18%, the free-PSA test significantly improved the differential diagnosis of BPH and CaP in the ’gray zone’ as compared to the use of total PSA alone in the study group.

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