title: High serum prostate-specific antigen levels in the absence of prostate cancer in Middle-Eastern men: the clinician's dilemma.
abstract: OBJECTIVE
  To investigate the common causes of total serum prostate-specific antigen (PSA) values of> 10 ng/mL in an Arab population, as in the USA and Europe the risk of prostate cancer is considered high in men with such PSA levels.
  
  
  METHODS
  Serum total PSA was measured in men presenting to our hospital as part of the investigation for prostate cancer screening and/or in elderly men with prostatism. Men with a serum PSA level of> 10 ng/mL were further investigated by transrectal ultrasonography (TRUS) of the prostate and biopsy of suspicious lesions for histological diagnosis. In addition, the percentage of free PSA, PSA velocity and PSA density were determined. All the patients included in this study were men of Arab origin residing in Kuwait.
  
  
  RESULTS
  In all, 1700 men (mean age 55.6 years, range 35-94) were assessed; of these, 161 had a serum PSA of> 10 ng/mL, attributable to benign prostatic hyperplasia (BPH) in 110 (68%), BPH with histological features of prostatitis in 33 (21%) and prostate cancer in 18 (11%). TRUS of the prostate in 143 of the 161 men with either BPH or BPH with prostatitis showed varying grades of intraprostatic calcifications in 22 (15%). Both PSA density and percentage free PSA did not contribute to determining the causes of total PSA levels of> 10 ng/mL. There was a progressive decline in PSA in all patients with BPH and prostatitis, except one who at re-biopsy had prostate cancer (T1N0M0, G1).
  
  
  CONCLUSIONS
  Total PSA values of> 10 ng/mL in Arab men may be a result of BPH, BPH with prostatitis or prostate cancer, in that order. A gradual decline in total PSA (decreased PSA velocity) with time to < 4 ng/mL often confirms the diagnosis of BPH with prostatitis. The percentage of free PSA and PSA density may not be helpful in diagnosing prostate cancer with certainty in these patients. Compared with Caucasians in the USA and Europe, BPH and BPH with prostatitis appear to be more frequent causes of serum PSA levels of> 10 ng/mL in Arab men.
authors.affiliation: Department of Surgery, Mubarak Hospital & Faculty of Medicine, Kuwait University, Safat. ekehinde@hsc.kuniv.edu.kw
authors.forename: E O
authors.initials: EO
authors.lastname: Kehinde
authors.forename: M
authors.initials: M
authors.lastname: Sheikh
authors.forename: O A
authors.initials: OA
authors.lastname: Mojimoniyi
authors.forename: I
authors.initials: I
authors.lastname: Francis
authors.forename: J T
authors.initials: JT
authors.lastname: Anim
authors.forename: D
authors.initials: D
authors.lastname: Nkansa-Dwamena
authors.forename: K A
authors.initials: KA
authors.lastname: Al-Awadi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018912:Arabs; D001706:Biopsy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging; D011472:Prostatitis / Q000097:blood / Q000000981:diagnostic imaging; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020728:Transurethral Resection of Prostate; D014463:Ultrasonography
chemical_list: D017430:Prostate-Specific Antigen