Using Prostate-specific Antigen To Diagnose Prostate Cancer: Sailing in Uncharted Waters

Abstract Background: Many patients undergo unwanted prostate biopsy due to unreliability of prostate-specific antigen (PSA). PSA density (PSAD), free PSA, free-to-total PSA ratio, prebiopsy MRI are used to diagnose prostate cancer (PCa). Since 1863, correlations between inflammation and cancer have been identified and explored; thus, the role of various blood parameters in detecting cancer has been studied, especially neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Here, we evaluated whether these parameters before prostate biopsy can diagnose prostate cancer in our hospital.Methods: We conducted a retrospective study from January 2014 to January 2018. Prostate cancer patients were divided into significant cancer (Gleason Score ≥ 7) and insignificant cancer (Gleason Score < 7). NLR, PLR, and other clinical parameters were taken before the prostate biopsy. We then analyzed the associations of NLR and PLR alone or with PSA, with significant prostate cancer. Results: We included 463 patients, of whom 60.3% (279) had prostate cancer and 75.6 % (211) had a Gleason score (GS) of ≥ 7. PSA and PSAD in the clinically significant prostate cancer patient group were around two times more than those in the insignificant prostate cancer group. PV, NLR, PLR, and combined markers were more in the GS ≥ 7 population group. PSA combined with PLR (PPLR) and PSA with NLR (PNLR) had better area under a curve (AUC) (0.732 and 0.730, resp.), with statistical significance, than PSA, NLR, and PLR alone (0.723, 0.585, and 0.590). In the multivariate analysis using separate models with PSA and NLR or PLR compared to age, DRE-positive lesions, PV, PSAD; PNLR, and PPLR were statistically significant in finding aggressive prostate cancer. When combined markers were used together, despite the high correlations, PSA and NLR were nearly significant (p = 0.062) in detecting the GS ≥ 7 population.Conclusion: The combined use of PSA with PLR and PSA with NLR helps detect the differences between clinically significant and insignificant prostate cancer.

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IS IT NECESSARY TO DIAGNOSE PROSTATE CANCER WITH A PROSTATE SPECIFIC ANTIGEN (PSA) OF < 4.0 NG/ML?

The Journal of Urology ◽

10.1097/00005392-199904020-00299 ◽

1999 ◽

pp. 324

Author(s):

Joachim Noldus ◽

Alexander Haese ◽

Markus Graefen ◽

Hartwig Huland

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Diagnose Prostate Cancer

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Optimal Monitoring of Prostate-Specific Antigen Detects Prostate Cancer at the Localized Stage after Photoselective Vaporization for Benign Prostatic Hyperplasia

Current Urology ◽

10.1159/000489433 ◽

2018 ◽

Vol 12 (3) ◽

pp. 147-152

Author(s):

Jun Furusawa ◽

Yasushi Yamada ◽

Norihito Soga ◽

Isao Kuromatsu

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Clinical Stage ◽

Specific Antigen ◽

Optimal Monitoring ◽

Prostate Biopsies ◽

Before And After ◽

Photoselective Vaporization ◽

Diagnose Prostate Cancer ◽

Pathologic Analysis

Introduction: Photoselective vaporization of the prostate (PVP) does not provide prostate tissue for pathologic analysis. Here, we carried out early monitoring for prostate cancer by measuring prostate-specific antigen (PSA) levels and assessing clinicopathological features after PVP. Materials and Methods: Patients (n = 800) who underwent PVP and were followed-up for more than 12 months were analyzed retrospectively. After PVP, PSA levels were measured at 3 and 12 months and each year thereafter. Prostate biopsies were performed when PSA levels increased continuously. We assessed the characteristics of patients diagnosed with prostate cancer. Results: The mean follow-up period was 49 months. After PVP, 54 patients underwent biopsies, and 23 patients were diagnosed with prostate cancer. Overall, 10, 10, and 3 patients had clinical stage T1c, T2a, and T2b disease, respectively, and there were no cases of stage T2c disease or greater. Conclusions: We found that it was possible to diagnose prostate cancer at a localized stage under our optimal PSA monitoring schedule before and after PVP.

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