Between-subject variations of transition zone epithelial volume and serum PSA levels in men with benign prostatic hyperplasia.
OBJECTIVE
We verified if the measure of transition zone epithelial volume (TZepiV) could be a valid predictor of serum PSA value in men with benign prostatic hyperplasia (BPH).


METHODS
Between January 2005 and July 2008, a total of 90 patients undergoing transvesical suprapubic adenomectomy for sintomatic BPH were enrolled. In case of an elevated PSA level (above 4 ng/ml) or abnormal digital rectal examination, systematic multisite biopsies were performed preoperatively to rule out prostate cancer. We have examined PSA levels before and after open surgery, TZ weight as measured by the pathologist and TZepiV by multiplying percentage of epithelium of a single biopsy core with the weight of adenoma. Means, Spearman correlation coefficients and percent change were calculated for all variables and intervals.


RESULTS
The mean serum PSA decreased from 4.8 ng/ml preoperatively to 0.5 ng/ml postoperatively. The mean decrease in PSA was 90% (range 70-99%).The mean weight of enucleated adenoma was 67 gr.(range 18-201) and the TZepiV was 7.7 ml (0.3-28.4). Overall, both TZ volume and TZepiV were correlated to PSA value with TZepiV representing the most predictive variable for PSA (r = 0.54 P = 0.002 vs. r = 0.26 P = 0.02). When we analyzed different ranges of PSA values, only TZepiV was always significantly proportional to PSA.


CONCLUSIONS
Ninety percentage of serum PSA level comes from TZ in range of 0.01-0.17 ng/ml/gr. In presence of equal BPH volumes, the amount of epithelium can be different and it is the main determinant in PSA increase. Thus, TZ epithelial volume could represent a new useful clinical tool able to increase the specificity of PSA in the diagnosis of prostate cancer.
Oreste
Martella
M
Division of Urology, G Mazzini Hospital, Teramo, Italy. oreste.martella@virgilio.it
Giuseppe
Paradiso Galatioto
PG
Gianna
Pace
P
Adriano
Angelucci
A
Stefano
Necozione
N
Mauro
Bologna
B
Carlo
Vicentini
V
D000236:Adenoma / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D004848:Epithelium / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011336:Probability; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D020728:Transurethral Resection of Prostate / Q000379:methods; D016896:Treatment Outcome; D047368:Tumor Burden
D017430:Prostate-Specific Antigen
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