Elevation of Serum Total Prostate-Specific Antigen (PSA) Level as Predictor of Prostate Cancer (PCa) of Patient Following Transurethral Resection of Prostate (TURP)
Abstract
Prostate cancer (PCa) is a significant global health issue, particularly in aging populations. In Indonesia, it is the fifth most common cancer. Diagnosis is often complicated by benign prostatic hyperplasia (BPH), which also elevates Prostate-Specific Antigen (PSA), limiting its specificity. This study aimed to establish an optimal preoperative PSA cutoff and assess the predictive utility of PSA, Neutrophil-Lymphocyte Ratio (NLR), and PSA Density (PSAD) for detecting PCa in patients undergoing Transurethral Resection of the Prostate (TURP). A retrospective cohort study analyzed 152 patients undergoing TURP at Gadjah Mada University Hospital (May 2018–July 2024) using a consecutive sampling method. Preoperative serum Total PSA, NLR, and PSAD were evaluated against postoperative histopathology. Bivariate and multivariate logistic regression were used to analyze relationships, while Receiver Operating Characteristic (ROC) curve analysis determined the optimal PSA cutoff. Prostate cancer was diagnosed in 19.1% of patients (n=29). ROC analysis identified a preoperative PSA cutoff of >19.95 ng/mL for predicting PCa, yielding an Area Under the Curve (AUC) of 0.863, with 75.9% sensitivity and 75.6% specificity. The multivariate analysis confirmed that elevated preoperative PSA (Odds Ratio [OR] 3.648), NLR (OR 3.868), and PSAD (OR 9.553) were all significant independent predictors of a PCa diagnosis. Among these, PSAD emerged as the strongest predictive marker. Preoperative serum PSA, NLR, and PSAD are valuable independent predictors for PCa in patients undergoing TURP for symptomatic BPH. A PSA cutoff of >19.95 ng/mL is a clinically relevant diagnostic threshold for this specific population. Employing a multi-marker panel, with particular emphasis on PSAD, can enhance risk stratification and help clinicians identify high-risk patients warranting further investigation for PCa when planning a TURP procedure.
Keywords: Prostate Specific Antigen (PSA), Prostate Cancer (PCa), Benign Prostate Hyperplasia (BPH), Transurethral Resection of The Prostate (TURP)
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Abedi, A. R., Ghiasy, S., Fallah-karkan, M., Rahavian, A., & Allameh, F. (2020). The Management of Patients Diagnosed with Incidental Prostate Cancer: Narrative Review. Research and Reports in Urology, Volume 12, 105–109. https://doi.org/10.2147/RRU.S245669
Adhyatma, K. P., Prapiska, F. F., Siregar, G. P., & Warli, S. M. (2019). Systemic Inflammatory Response in Predicting Prostate Cancer: The Diagnostic Value of Neutrophil-To-Lymphocyte Ratio. Open Access Macedonian Journal of Medical Sciences, 7(10), 1628–1630. https://doi.org/10.3889/oamjms.2019.177
Anand, A., & Gupta, S. (2021). Prostate-specific antigen increase after urethral catheterisation: fact or myth. African Journal of Urology, 27(1), 43. https://doi.org/10.1186/s12301-021-00149-7
Anand Kumar, C., Amit Kumar, P., & Roshan, K. (2024). Histopathological Study of Prostatic Lesions in Transurethral Resection of Prostate Specimens in Correlation with Serum Prostate Specific Antigen Levels. International Journal of Health Sciences and Research, 14(3), 151–156. https://doi.org/10.52403/ijhsr.20240322
Awedew, A. F., Han, H., Abbasi, B., Abbasi-Kangevari, M., Ahmed, M. B., Almidani, O., Amini, E., Arabloo, J., Argaw, A. M., Athari, S. S., Atlaw, D., Banach, M., Barrow, A., Bhagavathula, A. S., Bhojaraja, V. S., Bikbov, B., Bodicha, B. B. A., Butt, N. S., Caetano dos Santos, F. L., … Dirac, M. A. (2022). The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Healthy Longevity, 3(11), e754–e776. https://doi.org/10.1016/S2666-7568(22)00213-6
Benson, M. C., Seong Whang, I., Olsson, C. A., Mcmahon, D. J., & Cooner, W. H. (1992). The Use of Prostate Specific Antigen Density to Enhance the Predictive Value of Intermediate Levels of Serum Prostate Specific Antigen. Journal of Urology, 147(3 Part 2), 817–821. https://doi.org/10.1016/S0022-5347(17)37394-9
Cho, H. J., Shin, S. C., Cho, J. M., Kang, J. Y., & Yoo, T. K. (2014). The role of transurethral resection of the prostate for patients with an elevated prostate-specific antigen. Prostate International, 2(4), 196–202. https://doi.org/10.12954/PI.14060
Dany, Y. A., Hendri, A. Z., & Soerohardjo, I. (2021). Prostate cancer profile in Dr. Sardjito General Yogyakarta. Journal of Thee Medical Sciences (Berkala Ilmu Kedokteran), 53(3). https://doi.org/10.19106/JMedSci005303202104
Daryanto, B., Trianto, R., Seputra, K., & Purnomo, A. (2024). Evaluation of Cutoff Point Prostate Specific Antigen (PSA) and Prostate Specific Antigen Density (PSAD) in Patients with Suspected Prostate Cancer. Medical Archives, 78(1), 12. https://doi.org/10.5455/medarh.2024.78.12-15
Deshpande, N. S., Dahe, S. V., Munemane, A. B., Dhokikar, G. D., & Karle, R. R. (2020). Histopathological study of prostatic lesions in correlation with serum prostate specific antigen levels in elderly men. International Journal of Research in Medical Sciences, 8(9), 3304. https://doi.org/10.18203/2320-6012.ijrms20203683
Farha, M. W., & Salami, S. S. (2022). Biomarkers for prostate cancer detection and risk stratification. Therapeutic Advances in Urology, 14. https://doi.org/10.1177/17562872221103988
Ferlay, J., Colombet, M., Soerjomataram, I., Parkin, D. M., Piñeros, M., Znaor, A., & Bray, F. (2021). Cancer statistics for the year 2020: An overview. International Journal of Cancer, 149(4), 778–789. https://doi.org/10.1002/ijc.33588
Kawahara, T., Fukui, S., Sakamaki, K., Ito, Y., Ito, H., Kobayashi, N., Izumi, K., Yokomizo, Y., Miyoshi, Y., Makiyama, K., Nakaigawa, N., Yamanaka, T., Yao, M., Miyamoto, H., & Uemura, H. (2015). Neutrophil-to-lymphocyte ratio predicts prostatic carcinoma in men undergoing needle biopsy. Oncotarget, 6(31), 32169–32176. https://doi.org/10.18632/oncotarget.5081
Luo, G., Guo, M., Liu, Z., Xiao, Z., Jin, K., Long, J., Liu, L., Liu, C., Xu, J., Ni, Q., & Yu, X. (2015). Blood Neutrophil–Lymphocyte Ratio Predicts Survival in Patients with Advanced Pancreatic Cancer Treated with Chemotherapy. Annals of Surgical Oncology, 22(2), 670–676. https://doi.org/10.1245/s10434-014-4021-y
Neeli, S., Sharma, M., & Musale, A. (2021). Prostate-Specific antigen: An overview and its current status in the diagnosis of prostate cancer. Indian Journal of Health Sciences and Biomedical Research (KLEU), 14(1), 22. https://doi.org/10.4103/kleuhsj.kleuhsj_97_19
Nnabugwu, I., Udeh, E. ihechi, Otene, C., Nnabugwu, C., Ugwumba, F., & Enivwenae, O. (2014). Serum total prostate-specific antigen values in men with symptomatic prostate enlargement in Nigeria: role in clinical decision-making. Clinical Interventions in Aging, 89. https://doi.org/10.2147/CIA.S73814
Palestinian Ministry of Health. (2006). Guidelines for the management and care of diabetes mellitus: Quick reference guide. https://apps.who.int/iris/bitstream/handle/10665/119807/dsa698.pdf;jsessionid=47048D534701EC6D651C0DF3399B5338?sequence=1
Pellegrino, F., Tin, A. L., Martini, A., Vertosick, E. A., Porwal, S. P., Stabile, A., Gandaglia, G., Eastham, J. A., Briganti, A., Montorsi, F., & Vickers, A. J. (2023). Prostate-specific Antigen Density Cutoff of 0.15 ng/ml/cc to Propose Prostate Biopsies to Patients with Negative Magnetic Resonance Imaging: Efficient Threshold or Legacy of the Past? European Urology Focus, 9(2), 291–297. https://doi.org/10.1016/j.euf.2022.10.002
Rawla, P. (2019). Epidemiology of Prostate Cancer. World Journal of Oncology, 10(2), 63–89. https://doi.org/10.14740/wjon1191
Sandhu, S., Moore, C. M., Chiong, E., Beltran, H., Bristow, R. G., & Williams, S. G. (2021). Prostate cancer. The Lancet, 398(10305), 1075–1090. https://doi.org/10.1016/S0140-6736(21)00950-8
Sekhoacha, M., Riet, K., Motloung, P., Gumenku, L., Adegoke, A., & Mashele, S. (2022). Prostate Cancer Review: Genetics, Diagnosis, Treatment Options, and Alternative Approaches. Molecules, 27(17), 5730. https://doi.org/10.3390/molecules27175730
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension, 75(6), 1334–1357. https://doi.org/10.1161/hypertensionaha.120.15026
Wadgaonkar, A., Patil, A., Mahajan, S., & Yengantiwar, R. (2013). Correlation of serum prostate specific antigen (PSA) in benign prostate hyperplasia, prostatitis, serum prostate specific antigen (PSA), adenocarcinoma, Gleason score. International Journal of Basic and Applied Medical Sciences, 3(2), 274–281.
Wei, J. T., Barocas, D., Carlsson, S., Coakley, F., Eggener, S., Etzioni, R., Fine, S. W., Han, M., Kim, S. K., Kirkby, E., Konety, B. R., Miner, M., Moses, K., Nissenberg, M. G., Pinto, P. A., Salami, S. S., Souter, L., Thompson, I. M., & Lin, D. W. (2023). Early Detection of Prostate Cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening. Journal of Urology, 210(1), 46–53. https://doi.org/10.1097/JU.0000000000003491
Wu, J., Pan, C. B., Xie, S. H., Tang, B., Fu, J., Wu, X., Tong, Z. G., Wu, B. W., Yang, Y. Q., Ding, H., Li, S. Y., & Hong, T. (2022). A propensity-adjusted comparison of endoscopic endonasal surgery versus transcranial microsurgery for pediatric craniopharyngioma: a single-center study. Journal of Neurosurgery: Pediatrics, 29(3), 325–334. https://doi.org/10.3171/2021.10.PEDS21392
Yusim, I., Krenawi, M., Mazor, E., Novack, V., & Mabjeesh, N. J. (2020). The use of prostate specific antigen density to predict clinically significant prostate cancer. Scientific Reports, 10(1), 20015. https://doi.org/10.1038/s41598-020-76786-9
DOI: http://dx.doi.org/10.30829/contagion.v7i1.23972
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