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Incidental acute prostatic inflammation is associated with a lower percentage of free prostate‐specific antigen than other benign conditions of the prostate: a prospective screening study
Author(s) -
ROWE EDWARD W.J.,
LANIADO MARC E.,
WALKER MARJORIE M.,
ANUP PATEL
Publication year - 2006
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2006.06132.x
Subject(s) - medicine , prostate cancer , prostate , inflammation , prostate specific antigen , urology , prospective cohort study , asymptomatic , cancer , prostate biopsy , biopsy , oncology , gastroenterology
OBJECTIVE To evaluate the performance of percentage free/total prostate‐specific antigen (f/tPSA) as a screening tool for prostate cancer, and to assess the impact of prostatic inflammation on f/tPSA. PATIENTS AND METHODS Men aged 50–65 years were invited for prostate cancer screening. Biopsies were taken from men with a tPSA of ≥ 4 ng/mL, together with those with a tPSA of 1.1–3.99 ng/mL and a f/tPSA of ≤ 20%. Histological evidence of prostate cancer, acute inflammation, chronic inflammation, and benign prostatic tissue were noted in biopsy cores, together with the associated f/tPSA values. RESULTS The cancer detection rate was 4.3% (33/773). Evidence of inflammation was found in about half (87/175) of those biopsied. Men with acute inflammation (27/175, 15%) had significantly lower serum f/tPSA values (mean 13.4%) than those with chronic inflammation (mean 16.6%, P = 0.002) and benign prostatic tissue (mean 15.7%, P = 0.034), but were similar to men with prostate cancer (mean 15.3%, P = 0.315). CONCLUSIONS In this prospectively screened cohort of men, there was a high incidence of asymptomatic inflammation on prostatic histology; f/tPSA values were significantly lower in men with acute inflammation. This might explain the variability of f/tPSA in improving specificity when used as a screening tool for prostate cancer, and might also reduce its effectiveness in differentiating tumours with more aggressive potential.