Constitutive expression of high levels of prostate-specific antigen in the absence of prostate carcinoma.
OBJECTIVE
To identify distinguishing serologic features in patients with stable marked elevation in prostate-specific antigen (PSA) and multiple negative biopsies.


METHODS
The study population consisted of 7 patients with a stable PSA level of greater than 20 ng/mL (average 27.0), followed for at least 34 months (average 56), and with two or more negative prostatic biopsies including transition zone biopsies. The PSA density (PSAD), rate of change in PSA, reverse transcriptase/polymerase chain reaction (RT/PCR), and free/total PSA were obtained.


RESULTS
Rate of change in PSA level was stable (0.18 +/- 1.2 ng/mL/yr), suggesting that there was no occult cancer; PSAD was high (0.34 +/- 0.5 ng/mL/cc), indicating that prostate size was not the sole cause of the elevation. The RT/PCR was negative in 6 of 7 patients, further decreasing the likelihood of an occult malignancy. Free versus total PSA was not consistent, averaging 16.8%, but with a range of 6% to 34%.


CONCLUSIONS
Novel PSA tests were not found to be useful in this cohort of patients with multiple negative biopsies and PSA elevations greater than 20 ng/mL. Additional studies with larger sample size are required to confirm this finding.
Division of Urology, Beth Israel Hospital, Boston, MA 02215, USA.
A S
AS
Kibel
K
K
Krithivas
L B
LB
Shamel
P W
PW
Kantoff
W C
WC
DeWolf
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis; D014463:Ultrasonography
D017430:Prostate-Specific Antigen