Diagnostic Utility of PSA for Detection of Prostatic Lesions

Abstract

INTRODUCTION: Prostatic carcinoma has become the most common type of cancer and second most common cause of death due to cancers in male patients. According to American cancer society, a man has 1 in 6 chance of developing prostate cancer during his lifetime. Extensive efforts have been made at primary and secondary level for preventions since curative treatments are limited to early stages of the disease, the availability of an efficient, easy to test, broadly acceptable, cost effective, method for diagnosis of prostatic cancer is essential. There has been an ongoing research for a tumor marker more sensitive and specific than prostate acid phosphatase (ACP) for prostate cancer, since the levels of ACP are usually affected by iso-enzymes generated by other organs. This led to the discovery of some antigens that subsequently became known as prostate specific antigen (PSA). Now, PSA is recognized as the best tumor marker for prostate cancer. Prostate specific antigen (PSA) is a kallikrein like serine protease produced entirely by the epithelial cells of prostate. Although increased PSA levels have been found to be closely related with prostate cancer, there can be different reasons for an elevated PSA level, including benign prostatic hyperplasia, prostatitis, prostatic trauma, and prostatic infarction. The addition of measurement of serum PSA level to digital rectal Examination for early detection of prostate cancer, has improved the percentage of prostatic cancer detection over the last several years. xiii METHODS A total number of 100 prostatic biopsies collected from january 2016 to january 2017 at DHIRAJ hospital, Piparia-vadodara. The tissues were fixed in 10% formalin and processed routinely. The PSA levels will be estimated in the Department of Biochemistry, Dhiraj hospital, piapria-gujarat. The PSA levels were estimated using the TOSOH- immunoassay AIA360, chemiluminescence system which estimates PSA by a sandwich assay utilizing a constant amount of 2 antibodies-labelled polyclonal sheep antibody and monoclonal mouse antibody. They were graded into benign, inflammatory conditions and malignant lesions. Gleason`s microscopic grading was used to grade all the prostatic adenocarcinoma cases. Serum PSA levels were correlated in all the cases. RESULTS There were 90 TURP, 8 Needle biopsies and 2 prostatectomy specimens. Most of the patients were in sixth and seventh decade. Lesions encountered were benign prostatic hyperplasia / prostatitis 85%, LGPIN 7% and 8% malignant. CONCLUSION Benign Prostatic Hyperplasia was the common lesion encountered. Associated lesions like prostatitis BCH, CCCH, transitional metaplasia, granulomatous prostatitis, abscesses were encountered. Among the malignant lesions adenocarcinoma was the common lesion seen in sixth decade and Gleason`s score 7 was the commonest. One of the case sent as metastatic TCC from bladder was confirmed histologically. Serum PSA levels were elevated in few cases of benign lesions due to associated lesions like prostatitis, abscesses and granulomatous prostatitis. Many of the malignant cases showed very high levels of PSA.