What kind of differences are there between BPH and prostate cancer regarding PSA and its derivates?

Bu çalışmamızda, BPH ve prostat kanseri tanılı hastalardaki PSA, serbest/toplam (s/t) PSA oranları ve PSA dansitelerini (PSA-D) karşılaştırmayı, prostat kanserli hastalardaki Gleason skorları ile PSA ilişkisini ortaya koymayı ve BPH’lı hastalarda yaşa bağlı PSA değişimlerini analiz etmeyi amaçladık. Ocak 2001-Aralık 2003 tarihleri arasında kliniğimizde BPH nedeniyle cerrahi uygulanan ve primer olarak prostat kanseri tanısı alan toplam 662 hastanın verileri geriye dönüşümlü olarak incelendi. BPH hastalarının yaş ortalaması 68.5 prostat kanserli hastalarının ise 66.9 idi. Prostat kanseri grubunda ortalama PSA değeri 32,3 ng/ml (0,4-165,6 ng/ml), BPH grubundakilerde ise 5,3 ng/ml (0,2-19,4 ng/ml) idi. PSA dansitesi hesaplanan prostat kanserli ve BPH’lı hastaların ortalama ve ortanca PSA-D değerleri sırasıyla 1,38 ve 0,54 ile 0,08 ve 0,06 idi. Kanserli grupta s/t oranlarının ortalaması 0.14 (0,01-0,72) ve ortancası 0,12, BPH grubundakilerin s/t PSA ortalaması 0,19 (0,01-0,70) ve ortancası 0,19 idi. BPH grubunun yaşa göre ortalama ve ortanca PSA değerleri 40-49 yaş grubunda 1,93 ve 2.0, 50-59 yaş grubunda 3.39 ve 2.25, 60-69 yaş grubunda 4.18 ve 3,0, 70 yaş üstünde 5,79 ve 4,50 olarak belirlendi. s/t PSA oranı ve PSA-D prostat kanseri ve BPH olgularında anlamlı farklılık göstermektedir. Gleason skorları PSA ile koreledir ve yaşa özgü PSA oranları geçerlidir.
Introduction: Prostate cancer is one of the most important malignancies of male population because of its high morbidity and mortality. Early detection is important to obtain better treatment outcome. Prostate specific antigen (PSA) is a key marker for early detection of prostate cancer. The aim of this retrospective study is to compare prostate specific antigen (PSA) and free/total PSA (f/t PSA) ratios in patients with benign prostatic hyperplasia (BPH) and prostate cancer. In addition, PSA alterations’ correlation with Gleason score in prostate cancer patients and age-specific PSA levels in BPH patients were analysed. Materials and Methods: A total of 662 patients, who underwent surgical treatment for BPH or patients diagnosed with primary prostate cancer at Urology Department of Ege University between January 2001 and December of 2003, were recruited in the current study. All data were achieved from patient data archives retrospectively. Patients were analysed in 2 groups: BPH (543 patients) and prostate cancer (119 patients) patients. We compared PSA, f/t PSA ratios and PSA density (PSA-D) between 2 groups. We also reviewed the correlation between PSA levels and Gleason score in prostate cancer patients and age-specific PSA levels in BPH patients. Statistical analysis was done with SPSS 10.0. Results: 321 of 543 BPH cases underwent transurethral resection of prostate (TURP) and 222 BPH cases underwent suprapubic transvesical prostatectomy (SPTVP). 9 patients were diagnosed as prostate cancer pathologically who were considered as clinically BPH preoperatively. Median ages of the patients with BPH and prostate cancer are 68.5 and 66.9 years old, respectively. Median PSA in prostate cancer group was 32.3 ng/ml (0.4-165.6 ng/ml) and median PSA in BPH group was 5.3 ng/ml (0.2-19.4 ng/ml). 51 out of 543 BPH patients have PSA values more than 10 ng/ml (rate %9.3). f/t PSA ratios were available in 66 patients with prostate cancer. Median and mean f/t PSA ratios in this group were 0.14 (0.01-0.72) and 0.12, respectively. In BPH group, median and mean f/t PSA ratios were 0.19 (0.01-0.70) and 0.19, respectively. Mean PSA levels of prostate cancer patients with Gleason score of below 7.7 and above 7 were 22.7, 35.9, 32, respectively. Mean PSA levels stratified according to decades in BPH patients were 1.9 in 40-49 years old group, 3.4 in 50-59 years old group, 4.2 in 60-69 years old group, 5.8 in 70 years old and older group. Median and mean PSA density in prostate cancer (58 patients) cases were 1.38 and 0.54, respectively whereas median and mean PSA density in BPH (420) cases were 0.08 and 0.06, respectively. Conclusion: There is significant difference between prostate cancer and BPH patients with regards to f/t PSA and PSA-D values. In addition, PSA levels correlate well with Gleason scores in prostate patients. Agespecific PSA values are valid in BPH patients.