Correlation Between Serum Prostatic Specific Antigen and Prostatic Volume in Benign Prostatic Hyperplasia

Abstract

Introduction: Benign prostatic hyperplasia (BPH) is a progressive condition characterized by prostate enlargement accompanied by lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia arises in the periurethral and transition zones of the prostatic gland and represents an inevitable phenomenon for the ageing male population. An estimated 75% of men>50 years of age have symptoms arising from benign prostatic hyperplasia, and 20–30% of men reaching 80 years of age require surgical intervention for the management of BPH. Prostate specific antigen (PSA) is a serine protease produced by the prostate epithelium and periurethral glands in male. Serum PSA elevation occurs as a result of disruption of normal prostatic architecture that allows PSA to diffuse into prostatic tissue and gain access to the circulation. Benign prostatic hyperplasia, prostatic carcinoma and prostatitis are three common diseases where PSA in the serum is raised.

Aims and objectives: To evaluate the PSA level and To find out the relationship between serum PSA level and the volume of prostate in Benign hyperplasia of prostate.

Material and Methods: This is a Hospital based prospective study which was conducted in the Department of Surgery at Nepalgunj Medical College Teaching Hospital, th th Kohalpur, for a duration of 1 year from 13^th July 2015 to 12^th July 2016. A total of 30 cases were studied. Patients were chosen for the study on the basis of clinical history and DRE. Patient with LUTS symptoms and enlarged Prostate on DRE were further subjected to PSA screening through blood examination and Transabdominal ultrasound for measuring prostatic volume. Patients were explained about procedure and following consent, patients were subjected for TURP under spinal anesthesia/general anesthesia. Specimen was sent to the Department of Pathology, Nepalgunj Medical College for Histopathological evaluation.

Results: Out of 30 patients, one patient was of 44 years of age, rest of them were above 50 years of age and the mean age was 63.9±8.64 years. All the patients had voiding problems, of which 28 patients (94%) had obstructive symptoms and 27 patients (90%) had irritative symptoms. Most patients had history of nocturia which was present in 24 patients (83%). Mean PSA level was 6.36 ng/ml with a range of 3.2-12 ng/ml. Mean prostate volume measured by TAUS was 60.30 ml. and that by DRE was 38.33 ml. There was statistically significant positive correlation between PSA level and prostate volume measured by TAUS with Pearson's correlation coefficient (r=0.679).

Conclusion: The analysis of present study consisting of 30 patients showed that mean PSA and prostate volume increased with advancing age, and the correlation between PSA and prostate volume estimated by TAUS in BPH as found to be statistically significant (p< 0.05). DRE underestimated the volume of prostate with a mean difference 21.97 ml. The correlation of age of the patient with PSA and prostate volume are (r=0.128) and (r=0.036) respectively. The above value shows that both are statistically weekly positive but the association between age of patient and PSA seems to be higher in comparison to age of the patient and prostate volume.