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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 1  |  Issue : 3  |  Page : 77-79

Analysis of the Correlationship between Prostate Specific Antigen Related Variables and Risk Factor in Patients with Prostate Carcinoma


1 Department of Urology, the 150th Center Hospital of Chinese People's Liberation Army, Luoyang, Henan, China
2 Department of Urology, Henan Cancer Hospital, Zhengzhou, Henan, China

Date of Submission22-Dec-2014
Date of Acceptance22-Jan-2015
Date of Web Publication30-Jun-2015

Correspondence Address:
Daoyuan Wang
Department of Urology, the 150th Center Hospital of Chinese People's Liberation Army, No. 2, Huaxia West Road, Luoyang 471003, Henan
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2395-3977.159524

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  Abstract 

Aim: To investigate the correlation between the related variables of prostate-specific antigen (PSA) and risk factors in patients with prostate carcinoma.
Methods: The clinical records of 187 cases with prostate carcinoma, diagnosed by biopsy, were retrospectively analyzed to assess the correlation of PSA density (PSAD), free PSA (FPSA), and FPSA/total PSA (TPSA) with risk factors in prostate carcinoma.
Results: The results from "Spearman rank correlation analysis" and "rank sum test" revealed that TPSA and FPSA were positively correlated with risk factors for prostate cancer patients, whereas there was no correlation between F/TPSA and risk factors.
Conclusion: PSAD, FPSA, and the related variables of PSA may serve as valuable tools to guide the treatment of prostate cancer.

Keywords: Free/total prostate-specific antigen, prostate cancer, prostate-specific antigen, prostate-specific antigen density


How to cite this article:
Wang D, Yang T, Zou Y, Yang X. Analysis of the Correlationship between Prostate Specific Antigen Related Variables and Risk Factor in Patients with Prostate Carcinoma. Cancer Transl Med 2015;1:77-9

How to cite this URL:
Wang D, Yang T, Zou Y, Yang X. Analysis of the Correlationship between Prostate Specific Antigen Related Variables and Risk Factor in Patients with Prostate Carcinoma. Cancer Transl Med [serial online] 2015 [cited 2017 Oct 18];1:77-9. Available from: http://www.cancertm.com/text.asp?2015/1/3/77/159524


  Introduction Top


The epidemiological data reveal that the incidence of prostate carcinoma increased in recent years, and the rate is growing. Prostate carcinoma has become a serious disease threatening the aged male population, which needs to be addressed soon. [1] Prostate-specific antigen (PSA), a glycoprotein secreted by prostate gland epithelial cells, serves as an important tumor marker in prostate cancer. Its related variables include total PSA (TPSA), free PSA (FPSA), PSA density (PSAD), and F/TPSA. Moreover, they are extensively used to assess the state of illness and the outcomes of treatment. A total of 187 patients diagnosed as prostate cancer were enrolled and the clinical data were retrospectively analyzed to investigate the correlation between the related variables of PSA and risk factors in patients with prostate carcinoma, which may provide guidance for clinical management.


  Methods Top


Patients

A total of 187 patients with prostate carcinoma admitted to the 150th Center Hospital of Chinese People's Liberation Army from January 2010 to November 2011 were analyzed. The ages range from 50 to 87 years, with the average age of 70.5 ± 8.7 years. All the cases had biopsy Gleason score, values of PSA, PSAD, F/TPSA and FPSA, transrectal ultrasonography, digital rectal magnetic resonance imaging, bone scan, and other related imaging examination. All patients received biopsies guided by transrectal ultrasound with the standard 12 needles.

Determination of indexes

Calculation of prostate-specific antigen related variables

Serum values of TPSA and FPSA of all cases were measured 2 weeks before puncturing. The volume of the prostate was measured by transrectal ultrasound. PSAD = TPSA/volume.

Gleason score

The Gleason scores for all patients' biopsy specimens were evaluated by the same pathologist. The standard Gleason score, ranging from 2 to 10, was graded as follows:

  • Gleason score 2-4: low grade or well-differentiated adenocarcinoma
  • Gleason score 5-7: moderate grade or differentiated adenocarcinoma
  • Gleason score 8-10: high grade or poorly differentiated adenocarcinoma.


Clinical staging

All the 187 cases of prostate cancer patients were analyzed by the 2002 American Joint Committee on Cancer staging tumor node metastasis system. The PSA related variables in relation with staging are shown in [Table 1].
Table 1: The basic clinical data of all patients


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Risk factors

According to the clinical stage, Gleason score, and serum PSA, prostate cancer can be divided into low, inter-medium, and high-risk levels, as shown in [Table 2].
Table 2: Risk factors for prostate cancer


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Statistical analysis

The statistical software SPSS17.0 (Chicago, IL, USA) was used for analyzing experimental results. Analysis of variance and covariance was used to determine whether there were significant relationships between the TPSA, FPSA, F/TPSA, PSAD, and prostate cancer risk factors of the 187 patients with prostate cancer. Comparison of the measurement data was analyzed by Spearman correlation analysis; P < 0.05 was considered statistically significant.


  Results Top


The correlation between TPSA and risk factors of prostate carcinoma are shown in [Table 3]. Spearman correlation analysis showed that TPSA was positively correlated with prostate cancer risk factors (r = 0.72344, P = 0.007). The average value of TPSA in low, intermediate, and high-risk groups were (7.5 ± 0.82) ng/mL, (18.22 ± 2.45) ng/mL, and (51.1 ± 28.51) ng/mL, respectively. There was statistical significance among groups (P < 0.01). The correlation between FPSA and risk factors of prostate carcinoma are shown in [Table 4]. Spearman correlation analysis showed positive correlation between prostate cancer risk factors and FPSA (r = 0.803, P = 0.0034). The average value of FPSA in low, intermediate, and high-risk groups were (0.77 ± 0.31) ng/mL, (3.13 ± 0.41) ng/mL, and (13.9 ± 11.34) ng/mL, respectively. There was statistical significance among groups (P < 0.01).
Table 3: TPSA values of the different risk factors


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Table 4: FPSA values of the different risk factors


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The correlation between PSAD and prostate cancer risk factors are shown in [Table 5]. Spearman correlation analysis showed that PSAD and prostate cancer risk factors were positively correlated (r = 0.804, P = 0.0057). The average value of PSAD in low, intermediate, and high-risk groups were (0.2 ± 0.75) μg/L/cm 3 , (0.49 ± 0.31) μg/L/cm 3 , and (1.68 ± 1.30) μg/L/cm 3 , respectively. There was statistical significance among groups (P < 0.01). F/TPSA values suggest no significant relation to risk factors of prostate cancer (P = 0.209).
Table 5: PSAD values of the different risk factors


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  Discussion Top


PSA is a specific glycoprotein with a molecular weight of 34 kD. It is produced in prostate gland epithelial cells and secreted directly into prostate gland duct system. PSA exists in the blood in three kinds of forms. The first one is free molecule, named FPSA; the second is PSA alpha-1 antichymotrypsin (PSA-ACT) complexes combined with α2M chymotrypsin resistance; and the third is a complex substance formed with α2M giant ball of protease, the PSA-α2M. Most of PSA in the blood is found circulating in the form of PSA-ACT, and trace amounts of FPSA and PSA-α2M. Serum PSA analysis is the most widely-used method to test screening subjects for prostate cancer as well as to evaluate its treatment outcomes. Papsidero et al.[2] was the first to report that the level of PSA increased in the serum of prostate cancer patient and established it for prostate cancer diagnosis, staging, prognosis, and monitoring index. Xia et al.[3] pointed out the association of serum PSA level with the degree of infiltration of prostate tumor. They showed that prostate tumor disturbs the normal physiological barrier. As the tumor grows, it leads to more PSA leaking into the blood. Na and Sun [4] reported that when TPSA is < 10 ng/mL and F/TPSA value is 0.16 ng/mL, the lesion has a good specificity and sensitivity values to differentiate benign and malignant prostate lesions. Lerner et al.[5] found that the F/TPSA value was irrelevant to neither clinical stage nor pathological classification of prostate cancer. In contrast, Bangma et al.[6] observed a relationship between the F/TPSA value and clinical stage. PSAD is a unit volume of the prostate PSA levels, and its initial study emphasized the sensitivity and specific degrees of PSA in prostate cancer screening. Taneja et al.[7] revealed the prostate capsule invasion TPSA, PSAD area under the receiver operating characteristic (ROC) curve values to be 0.62 and 0.69, respectively. PSAD had the closest correlation with capsule invasion of prostate cancer. Naya et al.[8] found that the area under the ROC curve to TPSA, PSAD values are 0.563 and 0.708, showing that PSAD value is more predictive than TPSA.

At present, many research reports are published on prostate cancer, relating its TPSA, FPSA, PSAD, and the Gleason scores with its clinical stage. In recent years, the related variables of PSA have been used as a method to estimate the prognosis of prostate cancer. Because of the characteristics of its parameters, the related variables of PSA are proved to be helpful in diagnosis, pathological classification, clinical staging, risk factor analysis, and the evaluation of the treatment outcomes of prostate carcinoma. Our study confirmed that TPSA, FPSA, PSAD but F/TPSA are positively correlated with prostate cancer risk factors. The results from our work expand our knowledge of the application range of the related variables of PSA. They not only make a vital contribution to understand the underlying biology but also provide guidance for the clinical management of the prostate carcinoma.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflict of interest.

 
  References Top

1.
Gu FL. Modern prostate cancer epidemiology. Beijing: People's Military Medical Press; 2003. p. 276-8. (in Chinese)  Back to cited text no. 1
    
2.
Papsidero LD, Wang MC, Valenzuela LA, Murphy GP, Chu TM. A prostate antigen in sera of prostatic cancer patients. Cancer Res 1980; 40 (7): 2428-32.  Back to cited text no. 2
    
3.
Xia TL, Deng FM, Feng T. The pathology foundation of serum prostate specific antigen increasing. Zhongguo Yi Kan 1994; 74 (5): 306-8. (in Chinese)  Back to cited text no. 3
    
4.
Na YQ, Sun G. China urology disease diagnosis and treatment guidelines. Beijing: People's Medical Publishing House; 2009. p. 48-9. (in Chinese)  Back to cited text no. 4
    
5.
Lerner SE, Jacobsen SJ, Lilja H, Bergstralh EJ, Ransom J, Klee GG, Piironen T, Blute ML, Lieber MM, Zincke H, Pettersson K, Peterson D, Oesterling JE. Free, complexed, and total serum prostate-specific antigen concentrations and their proportions in predicting stage, grade, and deoxyribonucleic acid ploidy in patients with adenocarcinoma of the prostate. Urology 1996; 48 (2): 240-8.  Back to cited text no. 5
    
6.
Bangma CH, Kranse R, Blijenberg BG, Schröder FH. The free-to-total serum prostate specific antigen ratio for staging prostate carcinoma. J Urol 1997; 157 (2): 544-7.  Back to cited text no. 6
    
7.
Taneja SS, Hsu EI, Cheli CD, Walden P, Bartsch G, Horninger W, Babaian RJ, Fritsche HA, Childs S, Stamey TA, Sokoll LJ, Chan DW, Brawer MK, Partin AW, Lepor H. Complexed prostate-specific antigen as a staging tool: results based on a multicenter prospective evaluation of complexed prostate-specific antigen in cancer diagnosis. Urology 2002; 60 (4 Suppl 1): 10-7.  Back to cited text no. 7
    
8.
Naya Y, Fritsche HA, Cheli CD, Stamey TA, Bartsch G, Brawer MK, Childs S, Taneja SS, Lepor H, Partin AW, Sokoll LJ, Chan DW, Babaian RJ. Volume indexes of total, free, and complexed prostate-specific antigen enhance prediction of extraprostatic disease extension in men with nonpalpable prostate cancer. Urology 2003; 62 (6): 1058-62.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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