Does asymptomatic inflammation increase PSA? A histopathological study comparing benign and malignant tissue biopsy specimens

Abstract

Aim: To determine the effect of inflammation on postage-specific antigen (PSA) levels in patients who were performed transrectal ultrasonography (TRUSG) guided prostate biopsy because of high PSA levels. Materials and method: 376 tissue specimens of 47 patients with BPH and 176 tissue specimens of 22 patients with prostate adenocancer were analysed histopathologically. Digital rectal examination, TRUSG, and PSA measurements were performed to all the patients before biopsy. Sextant biopsy was performed. Two pathologists examined all the biopsy specimens in blinded fashion. Inflammation pattern was categorized as glandular, periglandular, stromal and perivascular and intensity of inflammation graded from 1 to 3. Results: The mean age of the patients was 66.2 years. The mean serum PSA level of the initial biopsy was 8.7 ng/ml in the BPH and 13.4 ng/ml in the prostate Ca. No relation was found between the serum total PSA levels and prostate volume or patient’s age in BPH patients (P=0.258). In BPH patients stromal, periglandular, glandular inflammations did not increase PSA levels. Perivascular inflammation increased PSA levels significantly. Conclusion: The inflammation in perivascular field increases serum PSA levels (P=0.007). Although high serum PSA levels shows correlation with cancer in biopsy, there is no such significant relation with rebiopsy results and PSA levels at last studies. Because of this, these patients’ biopsy samples must be reinspected for infection findings and atipic biopsy or high grade PIN. The result of our study showed that histological perivascular infection within the prostatic gland is a significant factor to serum PSA levels in BPH. If you have negative biopsy sample, pathology must indicate the place of the infection. Follow up of this patient and rebiopsy time are decided according to the result of this negative biopsy sample.