title: Effect of histological inflammation on total and free serum prostate-specific antigen values in patients without clinically detectable prostate cancer.
abstract: OBJECTIVE
  We are often confronted with patients in the "gray zone" (prostate-specific antigen [PSA]<10 ng/mL) whose biopsies reveal no malignancy but only inflammation. We investigated the relationship between histological inflammation and total PSA (tPSA), free PSA (fPSA), and percentage of free PSA (f/tPSA) levels in patients without prostate cancer (PC).
  
  
  METHODS
  We studied 106 men with tPSA<10 ng/mL who had undergone biopsy that was negative for PC and who had no clinical prostatitis. Inflammation observed at biopsies was scored for inflammation type in each biopsy core by use of a four-point scale and was then correlated with tPSA, fPSA, and f/tPSA.
  
  
  RESULTS
  Different patterns of inflammation were found in each set of biopsies. Regression factor analysis was used to form two groups according to inflammation type: more chronic and more acute. Median tPSA, fPSA, and f/tPSA levels in the more chronic and more acute inflammation groups were 6.4 ng/mL, 1.09 ng/mL, and 15%, and 7.3 ng/mL, 0.79 ng/mL, and l2%, respectively. A significant difference was found in fPSA (p=0.003) and f/tPSA (p<0.001), whereas the difference in tPSA was not significant (p=0.200). Total PSA correlated with fPSA (r=0.4, p<0.001) but not with inflammation type (r=0.12, p>0.010). A correlation existed between inflammation type and fPSA (r=-0.31, p=0.001) and f/tPSA (r=-0.43, p<0.001) in that the fPSA and f/tPSA were lower in the group with more acute inflammation.
  
  
  CONCLUSIONS
  Subclinical inflammation has a significant influence on fPSA in patients with tPSA<10 ng/mL but without PC or clinical prostatitis. Subclinical inflammation is not characterized by elevated tPSA alone but also by a decreased fPSA, a tendency similar to that in PC.
authors.affiliation: Clinical Department of Urology, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia.
authors.forename: Goran
authors.initials: G
authors.lastname: Stimac
authors.affiliation: Clinical Department of Urology, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia.
authors.forename: Borislav
authors.initials: B
authors.lastname: Spajic
authors.affiliation: Clinical Department of Urology, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia.
authors.forename: Ante
authors.initials: A
authors.lastname: Reljic
authors.affiliation: Clinical Department of Urology, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia.
authors.forename: Josip
authors.initials: J
authors.lastname: Katusic
authors.affiliation: Clinical Department of Urology, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia.
authors.forename: Alek
authors.initials: A
authors.lastname: Popovic
authors.affiliation: Clinical Department of Urology, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia.
authors.forename: Igor
authors.initials: I
authors.lastname: Grubisic
authors.affiliation: "Ljudevit Jurak" Department of Pathology, "Sestre milosrdnice" University Hospital Center, Zagreb, Croatia.
authors.forename: Davor
authors.initials: D
authors.lastname: Tomas
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D062005:Biopsy, Large-Core Needle; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006801:Humans; D007610:Kallikreins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis; D011472:Prostatitis / Q000097:blood* / Q000175:diagnosis / Q000473:pathology
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen
keywords: Biopsy; Inflammation; Prostate-specific antigen; Prostatic neoplasms; Prostatitis