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.
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.


METHODS
Men aged 50-65 years were invited for prostate cancer screening. Biopsies were taken from men with a tPSA of > or = 4 ng/mL, together with those with a tPSA of 1.1-3.99 ng/mL and a f/tPSA of < or = 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.
Rowe
Edward W J
EW
Department of Urology, St Mary's Hospital and Wexham Park Hospital, London, UK. ed.rowe@ukgateway.net
Laniado
Marc E
ME
Walker
Marjorie M
MM
Anup
Patel
P
D000208:Acute Disease; D000368:Aged; D001706:Biopsy / Q000379:methods; D015331:Cohort Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011472:Prostatitis / Q000097:blood*; D012680:Sensitivity and Specificity
D017430:Prostate-Specific Antigen