Extraprostatic Production of Prostate Specific Antigen is Under Hormonal Control

The Value of Prostate-Specific Antigen in Diagnosis of Polycystic Ovarian Syndrome in Adolescent Girls

STUDY OBJECTIVE

This study was designed to evaluate and compare the serum total prostate-specific antigen (PSA) levels in adolescent girls in with and without polycystic ovarian syndrome (PCOS) to show whether evaluation of PSA levels have a diagnostic benefit over existing diagnostic criteria.

DESIGN

Case-control study.

SETTING

A territory referral center.

PARTICIPANTS

A total of 89 (15-19 years) nonobese (body mass index, 18-24.9) adolescents with PCOS (n = 42) and controls without PCOS (n = 47) were enrolled in the study.

INTERVENTIONS

Pathophysiological features of PCOS and serum total PSA levels were determined at the time of study enrollment.

MAIN OUTCOME MEASURES

Determination, comparison, and diagnostic performance of serum total PSA levels in diagnosis of PCOS in adolescent girls were the main outcome measures of the study.

RESULTS

The serum total PSA levels of adolescents with PCOS were detected to be higher than for control participants (0.63 ± 1.38 ng/mL vs 0.48 ± 0.95 ng/mL) without meeting statistical significance (P = .923). There was a correlation between total PSA levels and indices of insulin resistance like the homeostasis insulin resistance model (r = 0.414; P = .010). The serum total PSA level was not a discriminative parameter for diagnosis of PCOS in adolescent girls (area under the curve, 0.559; P = .476).

CONCLUSION

The serum total PSA level was not a predictor of PCOS in adolescent girls. This finding might be related to the extemporal nature of tissues capable of PSA production and lack of sufficient exposure interval to hyperandrogenemia, rather than lack of stimulatory relationship between serum androgens.

Reconnoitring the status of prostate specific antigen and its role in women

Prostate specific antigen is considered to be a tumour marker having maximum utility and specificity for prostate cancer since decades. After the discovery of methods to quantify different molecular fractions of prostate specific antigen (PSA), its usefulness in diagnosing early prostate cancer cases has increased tremendously. The "specificity" of PSA, is now challenged by many studies which proved that PSA, once believed to be secreted exclusively by prostatic epithelium, is also present in females. The exact biological role of extraprostatic PSA is still debatable though many theories substantiated by in vitro evidence has been put forward. With the advent of ultrasensitive analytical techniques, PSA is now quantifiable in female serum in its various molecular forms and this has led to many assumptions of it being useful as a marker in female breast cancers. In a similar scenario to prostate cancer, the ratio of free to total PSA is shown to be useful in detecting early breast cancer cases. It is also shown to be a good prognostic indicator and a predictor of response to therapy and recurrence. Apart from its role in breast cancer, it has been advocated to be a marker of hyper androgenic states in women like hirsutism and polycystic ovarian syndrome. Conflicting reports regarding the role of extra prostatic PSA is accumulating but it has been proven beyond doubt that PSA is no longer specific and confined to prostate gland. Various studies have registered that PSA is an ubiquitous molecule, secreted by hormone responsive organs and its synthesis is stimulated by androgens and progesterone but not oestrogens. In this article, a review of various literatures is done about the presence of extra prostatic PSA, its probable role in those sites as well as its utility as a tumour marker in breast cancer.

What are the possible reasons for urethral PSA varieties after radical prostatectomy?

OBJECTIVE

To examine the possible reasons for great varieties in urethral prostate specific antigen (urPSA) levels, in patients after radical prostatectomy (RP).

MATERIALS AND METHODS

In 46 patients with pros-tate cancer, PSA, urPSA, total testosterone, body-mass index (BMI) and the stage of androgenic alopecia (AGA) were determined. Forty-five patients underwent retropubic RP, while one underwent cystoprostatectomy with orthotopic bladder construction, due to bladder cancer.

RESULTS

Average patients age prior to surgery plus or minus standard deviation was 65.2 +/- 5.8 years. Average urPSA was 20.9 +/- 47.5 ng/ml (0.05 to 212 ng/ml, median 2.24 ng/ml). With urethral PSA cut-off of 2.0 ng/ml, two groups were formed: A (urPSA < 2.0 ng/ml) and B (urPSA = 2.0 ng/ml). Patients in the group A had significantly lower average AGA score, than the patients from the group B (2.4 +/- 1.3 vs. 4.4 +/- 2.2, p = 0.0003). In addition, patients from the group A had significantly lower pos-toperative PSA (0.07+0.08 ng/ml vs. 0.14 +/- 0.06 ng/ml, p = 0.0014).

CONCLUSIONS

The patients with higher urPSA have higher AGA scores and higher postoperative PSA. This phenomenon is probably the consequence of higher local dihydrotestosterone activity in the scalp and PSA-secreting urethral glands.

Is prostate-specific antigen a potential new marker of androgen excess in polycystic ovary syndrome?

AIM

To determine whether serum prostate-specific antigen (PSA) levels are increased in polycystic ovary syndrome (PCOS) and the possibility of PSA to be used as a diagnostic marker of hyperandrogenism in females.

METHODS

A total of 43 women with PCOS and 43 age-matched healthy females were recruited in this prospective case-control study. The subjects were compared by means of demographic parameters, hormonal and metabolic measures and serum PSA levels. The correlations between this marker and a wide variety of hormonal, biochemical, anthropometric measures were evaluated. Student's t-test, chi2-test and Spearman's correlation analysis were used for the statistical analysis where appropriate. Statistical significance was assumed with a value of P<0.05.

RESULTS

Mean body mass index, waist/hip ratio, Ferriman-Gallwey scores (FG), lutenizing hormone/follicle stimulating hormone ratio, insulin resistance, serum triglycerides and very low density lipoprotein levels were demonstrated to be significantly higher in PCOS (P=0.02, P=0.008, P<or=0.001, P<or=0.001, P=0.007, P<or=0.001, P=0.01, respectively). Total testosterone (TT), dehydroepiandrosteronesulfate (DHEAS) levels appeared to be significantly higher in PCOS (P=0.002, P<or=0.001, respectively). Serum PSA levels were found to be significantly higher in PCOS (PSA: 0.026+/-0.023 ng/mL in PCOS, PSA: 0.009+/-0.008 ng/mL in control cases, P<0.001). Sex hormone binding globulin (SHBG) was significantly lower in the subjects with PCOS (P<0.001). Additionally, positive correlations between PSA and FG scores (r: 0.417, P<or=0.001), PSA and TT (r: 0.456, P=0.03) and between PSA and DHEAS (r: 0.268, P=0.02) were found. A negative correlation between SHBG and PSA was apparent (r: -0.40, P=0.04).

CONCLUSION

PSA is a well-established tumor marker of prostatic adenocarcinoma. It is also shown to be produced by extraprostatic tissues and fluids. As the gene expression of PSA is upregulated by the androgens and progestins in hormonally responsive tissues, hyperandrogenic syndromes such as PCOS may be associated with elevated serum PSA levels. PSA appears to be a promising marker of endogenous androgen excess in females suffering from PCOS.

Urinary prostate specific antigen: is the clinical use likely?

Prostate specific antigen (PSA) blood test represents the standard procedure in prostate cancer (CaP) diagnosis and follow-up. However, determination of PSA in the urine, where PSA is present in much higher concentrations than in the blood, still remains in the field of research.

OBJECTIVES

To determine urinary concentrations of PSA (uPSA) in different groups of patients (pts.), and to estimate is it possible to differentiate benign and malignant prostate diseases and to follow-up the results of treatment.

METHODS

Between January 2001. and November 2003., urinary concentrations of PSA were determined at 142 pts. divided in seven groups: 1. young and healthy volunteers, 2. "BPH-24": pts. with benign prostatic hyperplasia (BPH) who collected the sample of 24-hour voided urine, 3. "BPH-I": pts. with BPH who collected the first portion of first urinary voiding, 4. "TRUS-CaP": pts. with CaP which gave the first portion of urine just prior to transrectal ultrasound-guided prostate biopsy (TRUS- biopsy), 5. "TRUS-non-CaP": pts. who gave first portion of urine prior to TRUS-biopsy, but biopsy did not prove the presence of CaP, 6. "RRP": pts. who underwent radical retropubic prostatectomy (RRP), 7. "AAT": pts. who underwent androgen deprivation therapy.

RESULTS

Average uPSA value in the group of young and healthy volunteers, was 13.8 +/- 19.6 ng/ml, in "BPH-24": 38.0 +/- 44.4 ng/ml, in "BPH-I": 140.8 +/- 140.9 ng/ml, in "TRUS-CaP": 234.8 +/- 277.7 ng/ml, in TRUS-non-CaP: 113.1 +/- 148.5 ng/ml, and in the group "RRP": 4.4 +/- 4.7 ng/ml. There was no statistically significant difference of average uPSA values between "BPH-I" and "TRUS-CaP" groups. The significant difference was found between the group of young volunteers and "BPH-I". In "TRUS-CaP" group, there was strong correlation between tumour size and aggressivenes and uPSA concentration. Finally, PSA and uPSA decline during androgen deprivation therapy, strongly correlated (up to r = 0.95).

CONCLUSIONS

Determination of uPSA cannot differentiate BPH and CaP. However, in the group of pts. with proven localized CaP, uPSA can provide additional information concerning T-staging. Moreover, simultaneous monitoring of PSA and uPSA response on hormonal therapy, can provide an early recognition of androgen-indiferent CaP (AIPCA) and hormone-resistent CaP (HRPCA).

Prostate-specific antigen in female urine: a prospective study involving 217 women

OBJECTIVES

Histomorphologic studies have provided evidence of prostate-specific antigen (PSA)-producing tissue in the female urethra. Some urine samples from women in a small series were positive for PSA, but no systematic investigation of this subject has been done to date.

METHODS

In a prospective study, we analyzed whether PSA occurs in the urine of women and what factors induce detectable PSA levels. The urine samples of 217 women were analyzed (Hybritech-Tandem E-PSA) under standardized conditions. The impact of urine pH and volume was investigated, and the results were correlated with clinical data (age, residual urine, urinary tract infection and prior sexual intercourse within 48 hours).

RESULTS

A positive PSA level greater than the detection limit of 0.1 ng/mL was found in 11% of the analyzed samples; their mean value was 0.29 ng/mL. pH correction did not result in a significant difference. The voiding volume had no influence on the PSA level. Among the cases of detectable PSA, women younger than 50 years of age (n = 14) had a mean PSA of 0.34 ng/mL and those older than 50 years (n = 9) a mean of 0.23 ng/mL. One of 9 women with and 22 of 208 women without residual urine volume had a detectable PSA level, as did 0 of 20 with and 23 of 197 women without urinary tract infection, and 3 of 7 with and 20 of 210 women without prior sexual intercourse within the previous 48 hours. None of the differences were significant.

CONCLUSIONS

A urine PSA level was detected in 11% of all women studied, with PSA values apparently age dependent. Any urine portion is suitable for analysis. No influence was determined for residual urine volume or urinary tract infection. Sexual intercourse may cause detectable PSA values, but the data of this study did not provide sufficient evidence for this hypothesis.

Serum and Urinary Prostate-specific Antigen and Urinary Human Glandular Kallikrein Concentrations Are Significantly Increased after Testosterone Administration in Female-to-Male Transsexuals

Background: The genes that encode prostate-specific antigen (PSA) and human glandular kallikrein (hK2) are up-regulated by androgens and progestins in cultured cells, but no published studies have described the effect of androgen administration in women on serum and urinary PSA or hK2.

Methods: We measured serum and urinary PSA and hK2 before, and 4 and 12 months post testosterone treatment by immunofluorometric methods in 32 female-to-male transsexuals.

Results: Mean serum PSA increased from 1.1 ng/L to 11.1 ng/L and then to 22 ng/L by 4 and 12 months post treatment, respectively; the corresponding mean values in urine were 17, 1420, and 18 130 ng/L, respectively. Serum hK2, another kallikrein closely related to PSA, remained undetectable at the three time points. However, urinary hK2 concentration rose from below the detection limit (&lt;6 ng/L) before treatment to 18 and 179 ng/L by the 4th and the 12th month of treatment, respectively. All changes were statistically significant (P &lt;0.001) at 4 months.

Conclusions: Testosterone administration increases serum and urinary PSA and urinary hK2 in women. These measurements may be useful as indicators of androgenic stimulation in women.

Retroperitoneoscopic approach to nephrectomy

Laparoscopic management of a variety of renal diseases has assumed an increasingly important role as an alternative to open surgery. At many institutions, the transperitoneal approach has been the more commonly employed technique because it creates a larger working space and reveals easily recognized landmarks. At the Cleveland Clinic, however, laparoscopic simple nephrectomy for benign disease and laparoscopic radical nephrectomy for cancer are preferentially approached retroperitoneoscopically. Herein, we present our technique of retroperitoneal laparoscopic nephrectomy.

Breast tissues in transsexual women--a nonprostatic source of androgen up-regulated production of prostate-specific antigen

The present study made use of the female transsexual model and sought to evaluate the contributions of the ovarian, endometrial, and breast tissues to the androgen up-regulated production of prostate specific antigen (PSA). Serum levels of PSA were significantly raised in female transsexuals before surgery, after long-term androgen therapy (mean +/- SE = 35.3 +/- 6.2 pg/mL) when compared with female transsexuals before surgery, but with no androgen therapy (mean +/- SE = 1.53 +/- 0.25 pg/mL). In addition, in androngenized female transsexuals, after surgery, concentrations of PSA (mean +/- SE = 14.5 +/- 2.8 pg/mL) were significantly lowered compared with androngenized female transsexuals after surgery, but the levels were, nevertheless, significantly higher than in normal females. Monthly i.m. injection of 250 mg Sustanon-250 to female transsexuals had raised serum testosterone levels to within the male range. In five subjects, in whom serial measurements were taken, serum testosterone levels were greatly raised 24 h after the testosterone therapy; the mean level (+/-SE) was 19.5 +/- 2.1 ng/mL. But in spite of these high testosterone levels, serum PSA levels (mean +/- SE = 2.2 +/- 0.9 pg/mL) were not significantly raised. However, after 12 months of androgen therapy, the mean (+/- SE) PSA level in these five subjects was 47 +/- 11.6 pg/mL and was significantly higher than the mean level in nonandrogenized female transsexuals. The present study confirmed that high levels of testosterone were able to up-regulate PSA production in women. This up-regulation of PSA production is both a dose- and time-dependent process. Furthermore, the evidence indicates that breast tissues are possibly a nonprostatic source of androgen up-regulated production of PSA women.