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RESEARCH ARTICLE
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 138-143

Measurement of serum PSA in benign and malignant enlargements of prostate in Indian population: Relevance of PSAD in intermediate range PSA


1 Department of Surgery, SN Medical College, Agra, India
2 Department of Surgery, DDU Hospital, New Delhi, India
3 Department of Medicine, SN Medical College, Agra, India

Correspondence Address:
Madhu S Agarwal
4/18c, Bagh Farzana, Civil Lines, Agra - 282 002
India
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Source of Support: None, Conflict of Interest: None


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Objectives : PSA has revolutionized the diagnosis and management of men with prostate cancer. However as PSA is organ-specific but not cancer-specific, its useful­ness is somewhat limited due to high false-positive and false-negative results. This study assesses the PSA levels in benign and malignant enlargements of prostate and evaluates the advantages of PSA density (PSAD) over PSA in early diagnosis of carcinoma of the prostate. Methods : This study was conducted on 184 cases of prostatic enlargement presenting with symptoms of out­flow obstruction. One hundred sixty of these patients had BPH and 24 were histologically proven carcinoma. Se­rum PSA and prostate volume using TRUS was measured in all patients. Results : In BPH, there was a statistically significant correlation of PSA with age and volume of the gland. In carcinoma of the prostate there was no correlation of a age and volume with PSA, but there was moderate correlation of PSA with clinical stage and significant correlation with Gleason scoring. PSAD was better correlated with the clinical stage and Gleason scoring as compared to PSA. PSAD demonstrated better specificity as compared to PSA in diagnosis of carci­noma, especially in the intermediate range (4-10 ng/ml). The construction of receiver operating characteristic (ROC) curves demonstrated the most appropriate cut-off value of PSAD to be 0.3 (at which level the sensitivity and specificity were 75% and 84.4% respectively), a level higher than those reported in American, European and Japanese literature. Conclusions: In this study, in northern Indian popula­tion, baseline values of PSA and PSAD in BPH patients were found to be higher than those reported in western literature. PSAD demonstrated better specificity as compared to PSA in diagnosis of carcinoma, especially in the intermediate range (4-10 ng/ml).


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