Correlating Histological Results and Total Serum Levels of the Prostate-Specific Antigen Among Patients in Southwestern Uganda.

Abstract

Background: Both healthy and malignant prostate tissues express the glycoprotein marker known as prostate-specific antigen (PSA). When checking for prostate lesions, serum total PSA levels are a major factor. However, the exact levels to rely on are not explicit.

Objective: To ascertain the relationship between histopathological findings and serum levels of the PSA in patients in southwest Uganda.

Methods: This cross-sectional study involved 71 participants in southwestern Uganda from January to July 2023, who underwent histological examinations. Blood samples were taken off for total serum PSA level measurement. Stained formalin-fixed paraffin-embedded sections were examined. Histological results and PSA levels were correlated using Spearman's correlation coefficient.

Results: The study involved 74 participants with an average age of 74.20 ± 9.40 years and average Gleason score of 7.73 ± 1.04. Only 1/71 (1.41%) had prostatic intraepithelial neoplasia (PIN), 36/71 (50.70%) had benign prostate hyperplasia (BPH), and 34/71 (47.89%) had prostate adenocarcinoma (PAC). A significant correlation was observed between PSA levels above 100 ng/mL (p = 0.001, rho = 0.5955) and prostate cancer and between PSA levels up to 20 ng/mL (p = 0.010, rho = 0.03033). AUC of 0.85 (95% CI: 0.77-0.94) showed good predictive power of the test. PSA optimal cut off was 103.4 ng/mL, at sensitivity of 68% and specificity of 92% with maximum Youden index (J): 0.595.

Conclusion: There was a significant correlation between BPH with PSA levels up to 20 ng/mL and above 100 ng/mL for prostate adenocarcinoma. In some of the cases, however, total serum PSA levels were high for BPH and low for prostate adenocarcinoma. PSA test usefulness cannot be nullified, but its accuracy and specificity have to be ascertained in order to increase its reliability. Future researches are argued to focus more on how to refine PSA-based diagnostics through identifying any underlying unknown hereditary factors and probably better biomarkers that could be influencing PSA levels. With this, dependability increases and unnecessary biopsing reduces, thus alleviating anxiety in patients and probably their caregivers.

Contributions of this study: The study provides additional insights into the importance and clarity of total serum PSA levels in prostate screening and diagnosis.