Histomorphologic Correlation of PSA Levels in Prostatic Pathology

摘要

Introduction: Nodular Prostatic Hyperplasia (NPH) and carcinoma of the prostate are increasingly frequent with advancing age. Early detection of these lesions can significantly reduce the patient mortality and morbidity. Prostate Specific Antigen (PSA) level estimation has become a popular method for screening prostatic lesions as it is easy to perform and is cost effective.Aim: To evaluate the role of PSA as a screening tool in different prostatic pathology including prostate cancer. Also, to assess the accuracy of PSA at a cut off 4 ng/ml and to correlate Gleason’s score with PSA levels.Materials and Methods: A total number of 170 prostatic biopsies from June 2012 to June 2016 received at the Central Diagnostic Laboratory, A.J Institute of Medical Sciences and Research Centre (AJIMS&RC), Mangaluru, India, was taken for the study. Paraffin embedded sections were stained with routine haematoxylin and eosin stain. The PSA levels were estimated in our Biochemistry Department. These values were correlated with histopathological diagnosis.Results: Out of 170 cases, there were 125 (73.5%) cases of NPH, 31 (18.2%) cases of prostatic adenocarcinoma, 5(2.8%) cases of prostatitis, 3 (1.76%) cases of urothelial carcinoma, 3 (1.76%) cases of low grade Prostatic Intraepithelial Neoplasm (PIN), 1 (0.58%) case of basal cell hyperplasia, 1 (0.58%) case of retention cyst, 1 (0.58%) case positive for small cell carcinoma metastasis. Based on the available PSA values 25 out of 31 cases of prostatic adenocarcinoma had a PSA value >10 ng/ml and 2 cases of prostatic adenocarcinoma had PSA value between 4 and 8 ng/ml. Correlation between Gleason’s score with age or PSA was not statistically significant.Conclusion: PSA is a valid, sensitive and early marker for the diagnosis of prostate cancer. With a cut off value of 4ng/ml the diagnostic accuracy is 56%, sensitivity was 96.67% and specificity was 38.5%. There was no correlation between Gleason’s score with age or PSA levels.