|IJHRS. 2014; 3(3): 99-106
The Role of Serum Prostate Specific Antigen in Management of Prostatic Diseases A Biochemical, Pathological and Clinical Audit of its Present StatusReshu Tewari, Swasti Sinha, Anurag Bajpai, Manisha Dwivedi, Shankar Madhav Natu, Divaker Dalela, Apul Goel.
Background: Elevated serum levels of Prostate Specific Antigen (PSA) are used as a tumor marker in the detection of prostatic malignancy, in monitoring of wide spectra of prostatic diseases and in formulating various treatment plans of cancer. The use of PSA is a much debated issue in the international literature till date. Keeping the practical difficulties in mind often experienced by our clinicians, further comprehensive clinicopathological and biochemical studies are recommended to explore and utilize the full potential of PSA including its newer parameters especially tailored to suit the Indian population.
Objectives: To locate the cutoff of serum PSA for establishing differential diagnosis of prostatic diseases and its impact on the therapeutic plan and assess the prognostic significance in context of North Indian population.
Materials and Methods: All the participants (men above 50 years of age with Prostrate disease) were subjected to comprehensive Clinicoinvestigative work up. The previous clinical, radiological and pathologic findings were recorded in all patients on follow up for different prostatic diseases. Prostate biopsies and transurethral resection of prostate (TURP) specimens were procured wherever indicated and processed routinely.
Results: Total 232 cases of different prostatic diseases as categorized on the basis of clinical and histopathological diagnosis, including Chronic Prostatitis, Benign prostatic hyperplasia (BPH), Benign hyperplasia of prostate with Prostatitis, High grade Prostatitis Intra Epithelio Neoplasia (HG-PIN) and Prostatic Carcinoma. The expected cut off value for subsequent total PSA was found to be 9.42 ng/ml at 80% sensitivity. In our study postulating that total PSA level at 9.42 ng/ml the probability of detecting true carcinoma cases would be 93% and only 7% cases would be likely to be missed.
Conclusion: PSA levels have been shown to lose their diagnostic power to differentiate between different histological groups in high-risk category. Despite the low sensitivity of PSA, it continues to be an extremely powerful diagnostic test. This pilot study has revealed significantly higher values for different categories of Prostatic disease conditions.
Key words: Prostatitis, High grade Prostatitis Intra Epithelio Neoplasia (HG-PIN), Prostate Specific Antigen (PSA)