Where does >90% of BPH develop?
Transition zone
Where does > 70% of prostate cancer develop[?
Peripheral zone
Describe PSA
- glycoprotein: part of the kallikrein family (also hk3).
2. functions as a serine protease
Where is PSA produced and secreted?
- Produced by epithelial cells in the prostatic acini* and ducts
- Secreted into the seminal fluid.
What are the other forms of PSA?
- Pre-Pro PSA
- Pro-PSA
A. Native form (-7)
B. Truncated forms (-5, -4, -2) - PSA
What fluids contain PSA?
- Semen
- Amniotic fluid
- Breast milk
- Saliva
- Female urine
- Female serum
How is PSA present in serum?
- Free, unbound form (~ 70%)
A. α1-antichymotrypsin (ACT)
B. α2- macroglobulin (A2M)
C. α1-protease inhibitor (API)
What are the approaches to improve diagnostic performance and reduce the number of biopsies?
PSA densities
PSA velocity
Define PSA density
- an adjustment that divides the PSA measurement by the gland volume
- fPSA/total PSA or tPSA ratio
Define PSA velocity
A. monitors the change in PSA with time.
B. Greater than 0.75 ng/mL per year is suggestive of cancer bc prostate cancer is typically slow growing
What are the assays for prostate disease?
- tPSA: measure free and complex forms, primarily ACT
- Free PSA
- Complex PSA
What are the low risk parameters for PSA?
<4.0 ng/ml
What is the PSA diagnostic grey zone?
4-10 ng/ml
What is the PSA high risk for cancer?
> 10 ng/ml
What are the risk factors for prostate cancer?
Black race
Family history
High-fat/low-vegetable diet
What are the preventative methods for prostate cancer?
Annual PSA and DRE after age 50
what is the clinical presentation of prostate cancer?
- Most common is asymptomatic elevation in PSA
- DRE findings of asymmetric indurations (hardening) or nodules are suggestive.
- Less common are obstructive symptoms, new onset ED, hematuria or hematospermia
What is %fPSA
% fPSA = (fPSA)/(tPSA) x 100
What is the % fPSA of men without prostate cancer?
> 25%
What is the fPSA of men with a risk for prostate cancer?
<25%
What is the cutoff for %fPSA to detect 90% of cancers?
27 %fPSA
What are the ri for PSA based on age?
0-2.5 aged 40-49 years
0-3.5 aged 50-59 years
0-4.5 aged 60-69 years
0-6.5 aged 70-79 years
What are the ri for black males for PSA based on age?
0-2 for men aged 40-49 years
0-4 for men aged 50-59 years
0-4.5 for men aged 60-69 years
0-5.5 for men aged 70-79 years
How do you treat early prostate cancer?
- Radical prostatectomy
- External beam radiation
- Brachytherapy (use of radioactive implants at the treatment site)
