Relationship of Prostate Specific Antigen & Prostate Specific Antigen Density and Prostatic Intraepithelial Neoplasia in Patient with Benign Prostatic Hyperplasia and Prostatic Cancer

Jeon, Cheol; Lee, Yeung Goo; Shim, Jeong Won

Abstract

Prostate intraepithelial neoplasia (PIN) is a putative premalignant change in the human prostate, which is an intraluminal proliferation of the secretory cells of the prostatic duct-acinar system that is enveloped by a basal cell layer and displays a spectrum of dysplastic cytologic features ranging from minimal atypia (low grade PIN) to those which are ultimately indistinguishable from carcinoma cells (high grade PIN). To evaluate the clinical significance of the PIN in prostatic tumor and BPH, we reviewed the serum prostate specific antigen (PSA), prostate specific antigen density (PSAD), and pathologic findings in the specimen of 21 BPH and 11 Prostate cancers, which were pathologically confirmed. The distributions of PIN are 7/21 (33%) in BPH and 8/ 11 (73%) in prostatic ca (P<0.05). The mean value (+/-SD) of PSA and PSAD in BPH patient were 8.42+/-5.57 ng/ml, 0.16+/-0.09 for PIN(-), 10.13+/-5.97 ng/ml, 0.17+/-0.09 for PIN(+), and in prostatic cancer patient were 60.53+/-1.83 ng/ml, 1.42+/-0.25 for PIN(-), 54.15+/-34.61 ng/ml, 1.28+/-0.84 for PIN(+), respectively. The mean value (+/-SD) of PSA & PSAD according to histologic types of BPH were 9.04+/-3.88 ng/ml, 0.17+/-0.06 for glandular type, 5. 57+/-1.31 ng/ml, 0.10+/-0.03 for stromal type, and 11.18+/-8.93 ng/ml, 0.19+/-0.13 for mixed type. The distributions of PIN according to histologic types of BPH were 30% (3/10) for glandular type, 40% (2/5) for stromal type, and 33% (2/6) for mixed type. All 7 PIN(+) BPH were low grade, while, of the 8 PIN(+) prostatic Ca, 1 was low grade and 7 were high grade. From these results, the frequent of PIN was higher in prostatic cancer than BPH (P<0.05). PIN had no significant influence on PSA elevation in prostatic cancer and BPH. There was no correction between PSA, PSAD and histologic types of BPH (P>0.05). There was no significant difference in the distribution of PIN according to histologic types of BPH. And high grade PIN was observed only in prostatic cancer. Therefore, if high grade PIN is observed in pathologic specimens, undetected prostatic cancer should be found.