Study of Free and Total PSA levels in Patients with Benign Prostatic Hyperplasia and Carcinoma Prostate

Author(s)

Joshi,, S., Naoley, R.D., Tilak, M.A.

Author's Affiliation

Abstract

The usefulness of PSA as an early detector of prostate cancer by itself is questionable owing to overlap in PSA values seen in patients with Benign Prostatic Hyperplasia (BPH) and in those with organ confined prostate cancer. Several workers used Free PSA levels to improve the specificity of Prostate Specific Antigen (PSA) for Prostate cancer. We studied 70 cases who presented in Surgical OPD with complaints of frequency, urgency of urination and hesitancy. They were tested for Free and Total PSA levels by chemiluminescent assay. Other biochemical markers tested were serum calcium, acid phosphatase and alkaline phosphatase. Along with this histopathological examination of prostatic biopsies was done. In our study of 70 cases it was found that the mean serum levels of Free PSA, Total PSA and free /total PSA ratio in BPH patients were 2.43±1.10, 8.51±5.20, 0.32±0.09, while in carcinoma patients mean serum levels were 1.59±0.55, 66.83±58.29, 0.04±0.03. In control groups of 30 patients mean serum levels were 0.68±0.56, 1.95±1.24 and 0.34±0.15. The results showed that mean Free PSA, Free /total PSA ratio was significantly decreased in carcinoma patients as compared to BPH patients. Total PSA levels were significantly increased in carcinoma as compared to BPH patients. A negative correlation was between Free/Total PSA ratio and histopathological findings. In our study clinical, biochemical parameters were correlated with biopsy report. Our study concluded that the Free PSA and free/Total PSA ratio were decreased in carcinoma prostate as compared to benign prostatic Hyperplasia (BPH). Total PSA levels were significantly increased in carcinoma prostate. So free/total PSA ratio helps in distinguishing between BPH & Carcinoma Prostate. Cut off value of free/total PSA ratio was 0.14 in our study. Patients above this cut off were BPH and below this were Carcinoma prostate. Above findings correlated with the biopsy report. We concluded that patients with prostate cancer have a greater fraction of bound PSA and a lower percentage of free PSA than in men without prostate cancer. There was a negative correlation found between free/total PSA ratio and the histopathologic findings. Lower the ratio higher is the grade of malignancy. Therefore in clinical practice Free/Total PSA ratio is crucial parameter which helps the clinicians  to decide if a biopsy is necessary or not. It is also helpful to screen the patients in the grey zone & helps in diagnosing prostate carcinoma cases which are usually missed.

Keywords

BPH, Carcinoma Prostate, free/Total PSA Ratio

Cite This Article

Joshi,, S., Naoley, R.D., Tilak, M.A. (2015). Study of Free and Total PSA levels in Patients with Benign Prostatic Hyperplasia and Carcinoma Prostate, International Journal for Pharmaceutical Research Scholars (IJPRS), 4(1), 205-209.