Dissertation
Dissertation > Medicine, health > Oncology > Genitourinary tumors > Male genitalia tumors > Prostate cancer

The Effect of Correlation Factors on Serum PSA Concentration

Author ChengZuo
Tutor LiXinDe
School Zhejiang University
Course Surgery
Keywords PSA TURP digital rectal exam prostate biopsy
CLC R737.25
Type Master's thesis
Year 2005
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Background:The serum PSA, produced primarily by the columnar epithelial cells of the prostate gland, is a single chain glycoprotein of 237 amino acids with a molecular mass of about 28430 Da. PSA belongs to the kallikrein family of proteases and is also called human kallikrein 3(hk3). In 1979, Wang and coworkers first determined the prostate specific antigen. In 1986, the PSA blood test was approved by the Food and Drug Administration(FDA) for prostate cancer monitoring, and in 1994 the FDA approved the test for the early detection of prostate cancer. To date, PSA is believed to be the most clinically useful tumor marker available for prostate cancer. In our country, because the use of PSA for the diagnosis of clinically prostate cancer , the prostate cancer especially the early prostate cancer is more and more in these years.The PSA concentration is higher in the men’s seminal fluid than in the serum. In Serum, PSA exists in different molecular forms, predominantly complexed to theprostease inhibitors alpha 1 -anti chymotrypsin, alphal-antitrypsin, andalpha2-macrogolbulin. Only 10-30% PSA is free in the serum and only 50-70% free PSA had the immunological activity. Although organ-specific, PSA is not a cancer specific marker. The serum is very sensitive for the diagnosis of early prostatecancer, but the specificity is not high. In clinical , the sensitivity is 90% and specificity is 30% if the serum PSA cutoff is 4.0ng/ml. While if the cutoff is lOng/ml, the specificity can increase to 70% and the sensitivity will decrease to 50%.To enhance the specificity of PSA with a minimal loss of sensitivity, measurement of free PSA and percent free PSA have been widely used, and some other index correlated with serum PSA had been reported, such as prostate-specific antigen density (PSAD), age specific PSA, prostate-specific antigen velocity(PSAV), prostate-specific antigen density of transition zone. It is know that various conditions such as benign prostate hyperplasia, prostate infection, or invasive manipulation of the prostate can cause elevation of the total serum PSA. But the effect of these conditions on free PSA and f/t PSA ratio is not clear and needs investigation. In the present study, we determined the effect of prostatic biopsy, DRE, TURP, acute urinary retention and prostate volum on serum total, free and free/total PSA ratio. The difference of serum total, free and free/total PSA ratio between prostate cancer and BPH is evaluated after prostatic biopsy.Methods:Between March 2004 and March 2005 132 patients with prostate disease were included in this study. The age is 46-85, mean 71.3 + 6.8 years old. 46 patients underwent TURP, 38 patients underwent the TRUS-guided prostatic biopsy, 14 patients got the acute urinary retention and DRE were performed in 34 patients. All patients with invasive manipulation of the prostate in 2 months and a history of and medications that could change serum PSA level were excluded from the study. The patient with bone metastatis because of prostate cancer or the total serum PSA is more than 60ng/ml was also excluded from the study. Serum tolal PSA, free PSA levels and free/total PSA ratio were determined when the the patient was admitted and lh,24h after TURP, TRUS-guided prostatic biopsy, and DRE by enzyme immunometric assay, we determined the effect of prostatic biopsy, DRE, TURP, acute urinary retention and prostate volum on serum total, free and free/total PSA ratio. The difference of serum total, free and free/total PSA ratio between prostate cancer and BPH is evaluated afterprostatic biopsy.All the data was analyzed by SPSS 10.0 for windows. We chose different statistical method depended on the different data information.Results:1 Effect of TURP on serum TPSA, FPSA, F/TPSAPostoperative total PSA and free PSA increased significantly compared with preoperative values and One hour after the TURP the serum f/t PSA also increased. But the difference between preoperative and 24h after operation f/t PSA ratios was not statistically significant.2 effect of prostatic biopsy on se

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