scholarly journals Change in Free To Total Prostate Specific Antigen Ratio Following Transurethral Resection of Prostate in Patient With Benign Prostatic Hyperplasia

2020 ◽  
Vol 18 (2) ◽  
pp. 83-87
Author(s):  
SM Yunus Ali ◽  
Md Saiful Islam ◽  
Mohammad Al Amin ◽  
Md Golam Mowla Choudhury ◽  
Isteaq Ahmed Shamim
Keyword(s):  
Prostate Specific Antigen ◽  
Transurethral Resection ◽  
Histopathological Examination ◽  
Urinary Tract Obstruction ◽  
Specific Antigen ◽  
Total Serum ◽  
Transurethral Resection Of Prostate ◽  
Free Psa ◽  
Lower Urinary Tract Obstruction ◽  
Total Psa

Objective- To determine the changes in free to total serum prostate specific antigen (PSA) ratio level after transurethral resection of prostate (TURP) in BPH patients at different interval of time. Materials & Methods- A total of 93 patients undergoing TURP for benign enlargement of prostate were included in the study. Serum total PSA and free PSA were assessed before operation and on the Ist and 7th postoperative day and at month 3 to determine the changes in total PSA, free PSA and free to total PSA ratio following TURP. Result- The preoperative mean total PSA, free PSA and free to total PSA ratio were 3.5 :L 1.7 ng/ml, 0.781 0.21 ng/ml and 0.28 + 0.07. In terms of IPSS, 75(80.7%) patients had severe lower urinary tract obstruction and 18(19.3%) moderate obstruction. Histopathological examination of the resected prostatic tissue revealed that all the 93 patients had benign prostatic lesion. Conclusion-The free and total PSA in first few days increases and thereafter it decreases in 3 months period following transurethral resection of prostate in men with BPH. As both these parameters decrease proportionately, the free to total PSA ratio remains consistent. If free to total PSA ratio decreases it raises suspicision about the early changes in malignancy. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.83-87

scholarly journals Heritability of Prostate-Specific Antigen and Relationship with Zonal Prostate Volumes in Aging Twins*

2000 ◽  
Vol 85 (3) ◽  
pp. 1272-1276
Author(s):  
Aruna Bansal ◽  
Darrell K. Murray ◽  
James T. Wu ◽  
Robert A. Stephenson ◽  
Richard G. Middleton ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Peripheral Zone ◽  
Monozygotic Twin ◽  
Total Serum ◽  
Free Psa ◽  
Two Factors ◽  
Total Psa ◽  
The Impact

Abstract Both benign prostatic hyperplasia and prostate-specific antigen (PSA) have been shown to increase with age and with prostate volume in men, but the influence of heredity on these relationships is not completely understood. This study has two aims: 1) to investigate the inter-relationships of age, PSA, and various zonal measurements in the prostate; and 2) to assess the impact of heritable influences on total PSA. Eighty-four monozygotic twin pairs and 83 dizygotic twin pairs were studied, and serum total PSA, free PSA, and PSA-∝1-antichymotrypsin were measured. Their prostate volumes [total (TV), transition zone (TZ), and peripheral zone) were quantitated using transrectal ultrasound. Total PSA is significantly correlated with all zonal prostate measurements (TZ, peripheral zone, TV, and TZ/TV) and with age. When linear regression was applied, only age and TZ were retained in the final model. The proportion of variability in total PSA explained by these two factors, however, is below 24%. In contrast, estimates of heritability show that approximately 45% of the variability in total PSA can be explained by inherited factors. Whereas age and TZ are linearly related to total PSA, their influence is much less than that of familial and genetic factors. It is uncertain whether these factors predispose also to prostate cancer or if they are independent of those, whether they confound the accuracy of using total serum PSA level as a diagnostic tool.

Effect of Marathon Running on Total and Free Serum Prostate-Specific Antigen Concentrations

2003 ◽  
Vol 127 (3) ◽  
pp. 345-348 ◽  
Author(s):  
Alexander Kratz ◽  
Kent B. Lewandrowski ◽  
Arthur J. Siegel ◽  
Patrick M. Sluss ◽  
Kelly Y. Chun ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Physical Exertion ◽  
The United States ◽  
Marathon Running ◽  
Reliable Determination ◽  
Free Psa ◽  
Sporting Event ◽  
Exercise Induced ◽  
Total Psa

Abstract Context.—Prostate-specific antigen (PSA) is an important tumor marker for the most frequently diagnosed cancer in the United States. A major limitation of this marker is falsely elevated results in patients who are found not to have prostate cancer. The effects of vigorous physical exertion on PSA concentrations are controversial. Objective.—To determine the effects of marathon running on PSA levels. Design.—Measurement of total and free PSA levels in the sera of participants in a marathon before and within 4 and 24 hours after the race. Results.—None of the participants had elevated total PSA levels before the race. Although we found no statistically significant changes in average total or free PSA concentrations at either time point, after the marathon, 2 (11%) of 18 runners had total PSA concentrations outside the standard reference range. Changes in total PSA levels did not correlate with age or prerace PSA concentrations. Free PSA levels were not statistically significantly changed after the race and did not allow a reliable determination of exercise-induced PSA elevations. Conclusions.—Although it may not be necessary for men to abstain from exercise involving running before blood draws for PSA analysis, elevated PSA concentrations may be observed in some individuals after participation in a major sporting event. In these cases, repeat measurements should be considered at a time significantly removed from such exercise.

scholarly journals The Combination of Human Glandular Kallikrein and Free Prostate-specific Antigen (PSA) Enhances Discrimination Between Prostate Cancer and Benign Prostatic Hyperplasia in Patients with Moderately Increased Total PSA

1999 ◽  
Vol 45 (11) ◽  
pp. 1960-1966 ◽  
Author(s):  
Angeliki Magklara ◽  
Andreas Scorilas ◽  
William J Catalona ◽  
Eleftherios P Diamandis
Keyword(s):  
Prostate Cancer ◽  
Benign Prostatic Hyperplasia ◽  
Prostate Specific Antigen ◽  
Prostatic Carcinoma ◽  
Specific Antigen ◽  
Area Under The Curve ◽  
Prostatic Hyperplasia ◽  
Free Psa ◽  
Glandular Kallikrein ◽  
Total Psa

Abstract Background: Prostate-specific antigen (PSA) is the most reliable tumor marker available and is widely used for the diagnosis and management of prostate cancer. Unfortunately, PSA cannot distinguish efficiently between benign and malignant disease of the prostate, especially within the range of 4–10 μg/L. Among the refinements developed to enhance PSA specificity is the free/total PSA ratio, which is useful in discriminating between the two diseases within the diagnostic “gray zone”. Recent data indicate that human glandular kallikrein (hK2), a protein with high homology to PSA, may be an additional serum marker for the diagnosis and monitoring of prostate cancer. Methods: We analyzed 206 serum samples (all before treatment was initiated) from men with histologically confirmed benign prostatic hyperplasia (n = 100) or prostatic carcinoma (n = 106) with total PSA in the range of 2.5–10 μg/L. Total and free PSA and hK2 were measured with noncompetitive immunological procedures. Statistical analysis was performed to investigate the potential utility of the various markers or their combinations in discriminating between benign prostatic hyperplasia and prostatic carcinoma. Results: hK2 concentrations were not statistically different between the two groups of patients. There was a strong positive correlation between hK2 and free PSA in the whole patient population. hK2/free PSA ratio (area under the curve = 0.69) was stronger predictor of prostate cancer than the free/total PSA ratio (area under the curve = 0.64). At 95% specificity, the hK2/free PSA ratio identified 30% of patients with total PSA between 2.5–10 μg/L who had cancer. At 95% specificity, the hK2/free PSA ratio identified 25% of patients with total PSA between 2.5 and 4.5 μg/L who had cancer. Conclusions: Our data suggest that hK2 in combination with free and total PSA can enhance the biochemical detection of prostate cancer in patients with moderately increased total PSA concentrations. More specifically, the hK2/free PSA ratio appears to be valuable in identifying a subset of patients with total PSA between 2.5 and 4.5 μg/L who have high probability of cancer and who should be considered for biopsy.

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

2013 ◽  
Vol 4 (1) ◽  
pp. 21-26
Author(s):  
S Ferdousi ◽  
MA Alim ◽  
Z Ferdous ◽  
A Khatun ◽  
N Sultana ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Prostatic Carcinoma ◽  
Specific Antigen ◽  
Total Serum ◽  
Serum Prostate Specific Antigen ◽  
Medical College ◽  
Carcinoma Prostate ◽  
Total Psa ◽  
Total Ratio

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. DOI: http://dx.doi.org/10.3329/bjmb.v4i1.13778 Bangladesh J Med Biochem 2011; 4(1): 21-26

Dual-label one-step immunoassay for simultaneous measurement of free and total prostate-specific antigen concentrations and ratios in serum

1995 ◽  
Vol 41 (8) ◽  
pp. 1115-1120 ◽  
Author(s):  
K Mitrunen ◽  
K Pettersson ◽  
T Piironen ◽  
T Björk ◽  
H Lilja ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Simultaneous Measurement ◽  
Solid Phase ◽  
Characteristic Curve ◽  
Specific Antigen ◽  
Sample Volume ◽  
Free Psa ◽  
One Step ◽  
Total Psa ◽  
Dual Label

Abstract We developed a simple one-step dual-label immunoassay for simultaneous measurement of the free, noncomplexed form of prostate-specific antigen (PSA) and total PSA. The assay is based on time-resolved fluorescence and includes a stable fluorescent chelate of Eu to label a monoclonal antibody (mAb) that detects only free PSA, whereas a second mAb labeled with a fluorescent chelate of Tb provides equimolar detection of both free PSA and PSA complexed to alpha 1-antichymotrypsin. A third mAb on a solid phase captures the free and complexed forms of PSA in an equimolar fashion. The simultaneous measurement of the free-to-total PSA ratio (F/T) with the one-step dual assay is not sensitive to variations in the sample volume. The discrimination between benign prostatic hyperplasia and prostate cancer patients, i.e., the area under the receiver-operating characteristic curve, increased from 0.64 (total PSA assay) to 0.78 and 0.81 when the F/T ratio was measured with single and dual assays, respectively.

scholarly journals Reference Reagents for Prostate-specific Antigen (PSA): Establishment of the First International Standards for Free PSA and PSA (90:10)

2000 ◽  
Vol 46 (9) ◽  
pp. 1310-1317 ◽  
Author(s):  
Brian Rafferty ◽  
Peter Rigsby ◽  
Matthew Rose ◽  
Thomas Stamey ◽  
Rose Gaines Das
Keyword(s):  
Confidence Interval ◽  
Prostate Specific Antigen ◽  
Recombinant Dna ◽  
Collaborative Study ◽  
Specific Antigen ◽  
International Standards ◽  
Serum Samples ◽  
International Standard ◽  
Free Psa ◽  
Total Psa

Abstract Background: Prostate-specific antigen (PSA) measurements in serum by immunoassay are widely used in the screening, diagnosis, and monitoring of patients with prostate cancer although the lack of common reference reagents has led in the past to wide differences in estimates. We report here the results of a WHO international collaborative study in which two preparations of PSA representative of the main immunoreactive components in serum, free PSA and PSA 90:10, and a preparation of recombinant DNA-derived PSA were assessed as potential standards for the calibration of diagnostic immunoassays for PSA. Methods: Coded vials of the candidate materials and serum preparations containing PSA in the clinically important range were provided to the 10 laboratories in the study, and participants were asked to perform PSA assays currently in use in their laboratories. Data from 89 immunoassays by 26 different method-laboratory combinations were contributed to the study and analyzed centrally at the National Institute for Biological Standards and Control. Results: Potency estimates of the preparations relative to the in-house calibrators were in good agreement with the target value of 1 μg of total PSA/vial, the preparation of free PSA giving 1.10 μg/vial (95% confidence interval, 0.99–1.21 μg/vial) and PSA 90:10, 1.11 μg/vial (95% confidence interval, 1.04–1.18 μg/vial). No immunoreactivity was detected in ampoules containing the recombinant material. Use of a common standard of PSA 90:10 significantly reduced the between-laboratory geometric coefficients of variation for serum samples included in the study and gave a much narrower range of potency estimates. Conclusions: The preparation of free PSA was established by WHO as the First International Standard for PSA (free) with an assigned content of 1 μg of total PSA per vial. In addition, the preparation of bound PSA was established as the First International Standard for PSA (90:10) with an assigned content of 1 μg of total PSA per vial.

scholarly journals Determination of Non-α1-Antichymotrypsin-complexed Prostate-specific Antigen as an Indirect Measurement of Free Prostate-specific Antigen: Analytical Performance and Diagnostic Accuracy

2003 ◽  
Vol 49 (6) ◽  
pp. 887-894 ◽  
Author(s):  
Sebastian Wesseling ◽  
Carsten Stephan ◽  
Axel Semjonow ◽  
Michael Lein ◽  
Brigitte Brux ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Sensitivity And Specificity ◽  
Specific Antigen ◽  
Roc Curves ◽  
Indirect Measurement ◽  
Free Psa ◽  
Specificity And Sensitivity ◽  
Diagnostic Sensitivity And Specificity ◽  
Total Psa

Abstract Background: A new assay measures prostate-specific antigen (PSA) not complexed to α1-antichymotrypsin (nACT-PSA) after removing PSA complexed to ACT by use of anti-ACT antibodies. We evaluated nACT-PSA and its ratio to total PSA (tPSA) as alternatives to free PSA (fPSA) and its ratio to tPSA in differentiating prostate cancer (PCa) and benign prostatic hyperplasia (BPH) in patients with tPSA of 2–20 μg/L. Methods: PSA in serum of 183 untreated patients with PCa and 132 patients with BPH was measured retrospectively on the chemiluminescence immunoassay analyzer LIAISON® (Byk-Sangtec Diagnostica) with the LIAISON tPSA and LIAISON fPSA assays. The nACT-PSA fraction was determined with a prototype assay measuring the residual PSA after precipitation of ACT-PSA with an ACT-precipitating reagent. Results:nACT-PSA was higher than fPSA in samples with fPSA concentrations <1 μg/L but lower in samples with >1 μg/L fPSA. The median ratios of fPSA/tPSA and of nACT-PSA/tPSA were significantly different between patients with BPH and PCa (19.4% vs 12.2% and 17.4% vs 13.0%, respectively). Within the tPSA ranges tested (2–20, 2–10, and 4–10 μg/L), areas under the ROC curves for the fPSA/tPSA ratios were significantly larger than those for nACT-PSA/tPSA. In the tPSA ranges <10 μg/L, the areas under the ROC curves for fPSA/tPSA were significantly larger than those for tPSA, whereas the areas for nACT-PSA/tPSA were not. At decision limits for 95% sensitivity and specificity, both ratios significantly increased specificity and sensitivity, respectively, compared with tPSA, but the fPSA/tPSA ratio showed higher values. Conclusions: nACT-PSA and its ratio to tPSA provide lower diagnostic sensitivity and specificity than fPSA/tPSA. The fPSA/tPSA ratio represents the state-of-the-art method for differentiating between PCa and BPH.

scholarly journals Effect of the Ratio of Free to Total Prostate-specific Antigen on Interassay Variability in Proficiency Test Samples

1999 ◽  
Vol 45 (8) ◽  
pp. 1181-1189 ◽  
Author(s):  
M Pat Fox ◽  
Andrew A Reilly ◽  
Erasmus Schneider
Keyword(s):  
Prostate Specific Antigen ◽  
Proficiency Test ◽  
Seminal Fluid ◽  
Specific Antigen ◽  
Free Form ◽  
Sample Mean ◽  
Substantial Impact ◽  
Free Psa ◽  
Total Prostate Specific Antigen ◽  
Total Psa

Abstract Background: Up to sevenfold differences were observed between total prostate-specific antigen (PSA) methods for New York State Proficiency Test samples prepared with seminal fluid PSA in human female serum. Because the PSA was mainly in its free form under these conditions, we wanted to determine whether a defined mixture of free and complexed PSA would reduce the interassay differences. Methods: We prepared a series of five solutions of 60 g/L bovine serum albumin with 10 μg/L total PSA consisting of varied proportions of free, noncomplexible PSA, and α1-antichymotrypsin (ACT)-complexed PSA from 0% to 100%. Two hundred seventy laboratories measured the total PSA in these samples, and 16 laboratories also analyzed the samples for free PSA. The results were used to calculate free/total PSA ratios. Results: Interassay CVs for total PSA measurements were ∼7% at 10–15% free PSA but became gradually larger as the free/total PSA ratio increased. Measured free-PSA concentrations were similar within each sample (mean CV, 12%), and the results were relatively independent of the proportion of free PSA in the samples. Twofold discrepancies between actual and expected ratios were observed with some methods at 100% free PSA and to a lesser degree at 30% free PSA. At 100% free PSA, the relatively higher total-PSA values measured by nonequimolar methods yielded low free/total PSA ratios of 50–60%. In contrast, the lower total PSA values obtained by equimolar methods yielded ratios close to the expected 100%. Conclusions: Preparing proficiency test samples with a 10:90 mixture of free, noncomplexible PSA:PSA-ACT is a viable alternative to the use of seminal fluid PSA. Furthermore, the method used to measure total PSA may have a substantial impact on the calculated proportion of free PSA and hence may have clinical relevance.

scholarly journals Comparison of prostate-specific antigen (PSA) measured by four combinations of free PSA and total PSA assays

1997 ◽  
Vol 43 (9) ◽  
pp. 1588-1594 ◽  
Author(s):  
Ralf Junker ◽  
Burkhard Brandt ◽  
Christian Zechel ◽  
Gerd Assmann
Keyword(s):  
Prostate Specific Antigen ◽  
Patient Population ◽  
Specific Antigen ◽  
Prostate Hyperplasia ◽  
Predictive Values ◽  
Negative Results ◽  
Free Psa ◽  
Gray Area ◽  
Total Psa ◽  
Benign Prostate

Abstract We compared prostate-specific antigen (PSA) assay systems [i.e., free PSA (f-PSA) and the corresponding total PSA (t-PSA) assay] from four different manufacturers as well as the f-PSA/t-PSA ratios with regard to their ability to discriminate between benign prostate hyperplasia (BPH) and prostate cancer (PCA). ROC analysis showed similar areas under the curves (AUCs) with different assay systems. For the entire patient population the AUCs of the f-PSA/t-PSA ratio were not or slightly increased compared with the sole measurement of t-PSA (t-PSA, 0.792–0.820; f-PSA/t-PSA ratio, 0.685–0.859). In contrast, for only those patients who showed t-PSA concentrations within the diagnostic gray area of 4–25 μg/L t-PSA, the AUCs were greater for the f-PSA/t-PSA ratio than for measurement of t-PSA alone (t-PSA, 0.608–0.647; f-PSA/t-PSA ratio, 0.690–0.806). These results were confirmed by the predictive values of the negative results (NPVs) of the t-PSA assays and the f-PSA/t-PSA ratios (assay thresholds corresponding to a 95% detection limit). Compared with the sole t-PSA measurement there was no mentionable increase in the NPVs due to the f-PSA/t-PSA ratio for the entire patient population, but an increase up to 49% when limited to t-PSA concentrations within 4–25 μg/L. We therefore conclude that the f-PSA/t-PSA ratio may be helpful for differential diagnosis of BPH and PCA within the diagnostic gray area of 4–25 μg/L t-PSA.

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