Prostate cancer
- is a malignant tumour that begins in the prostate gland
- most prostate cancer cells make excessive amounts
of a protein called Prostate Specific Antigen (PSA)
- PSA is also found in higher-than normal levels in men
with various other prostate conditions, such as benign
prostatic hyperplasia (BPH) and prostatitis, in addition
to prostate cancer.
- Age is the strongest risk factor for prostate cancer.
- Prostate cancer is very rare before the age of 40, but
the chance of having prostate cancer rises rapidly after
age 50
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Testing through the
- PSA blood test
- Digital Rectal Examination (DRE)
- and subsequent prostate biopsy
are currently mostly employed to detect the presence of
prostate cancer
- Early detection is key to enabling better outcomes and
potential cure of prostate cancer
It is recommended that men over the age of 50, be
screened for Prostate Cancer
- Screening can be started earlier (at 40) for men with a
family history of prostate cancer
The PSA test and DRE are part of the annual health check-
up.
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The main treatments for prostate cancer are
• Surgery
• radiotherapy
• hormone therapy
- Chemotherapy is also sometimes used
- important factors to consider when choosing
treatments are how fast the cancer is likely to grow and
how far it has already grown
A surgical approach to treating prostate cancer will remove
all or part of the prostate.
- men with early-stage disease or cancer that’s confined
to the prostate will undergo radical prostatectomy -
removal of the entire prostate gland, plus some
surrounding tissue
Radiation therapy involves killing of cancer cells and
surrounding tissues with directed radioactive exposure
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PSA
- is a glycoprotein expressed by normal, benign and
malignant prostatic tissue
- specific for the prostate (produced only by the
prostrate)
- but its not specific for malignancy
- can be elevated in other benign conditions such as
benign prostatic hyperplasia and prostatitis
- PSA is produced by acini and ductal cells of the
prostate
- It must be secreted into seminal fluids
- Functions to liquefy seminal coagulum to release
entrapped spermatozoa
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- The basement membrane prevents PSA from
escaping into the circulation before it is inactivated
- PSA must be inactivated before it escapes into
circulation
- If the basement membrane is disrupted by disease
e.g. in cancer, PSA overspills directly into circulation
before it is inhibited
There are 2 types of PSA
- Inactivated PSA- is good PSA (also known as Free PSA)
- Active PSA which is still complexed with α1-
antichymotrypsin, and α2-macroglobulin is bad PSA
- it is better to have more free, good PSA
• complexed (active) PSA should be as low as
possible
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Clinical implications of PSA
For Total PSA
• Levels below 4µg/l is considered normal
• Levels between 4 and 10µg/l is a grey zone
• Levels above 10µg/l are suggestive of Prostate
cancer
- PSA is useful in detecting, staging and monitoring
Prostate Cancer
- PSA is however not specific to Prostate Cancer
Levels of PSA in Benign Prostatic Hyperplasia can
overlap with levels of PSA in Early organ-confined
prostate cancer
- in both cases, PSA levels may be between 4 and 10µg/l
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How do we then increase specificity for detecting Early
stages of Prostate cancer
1. Use age-adjusted reference ranges
• 40-49 yrs must have PSA levels less than 2.5µg/l
• 50-59 yrs must have PSA levels less than 3.5 µg/l
• 60-69 yrs must have PSA levels less than 4.5 µg/l
• 70-79 yrs must have PSA levels less than 6.5 µg/l
2. PSA Density
- Ratio of PSA levels to Prostate volume
- Prostate volume is obtained by transrectal
ultrasonography
3. PSA velocity
- Rate of PSA increase overtime
- an increase rate above 0.75 µg/l per year is suggestive
of Prostate cancer
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4. Percentage of free PSA
- Free PSA is good, inactivated PSA
- Active, complexed PSA is bad PSA
- Free PSA less than 15% of total PSA is not good
- The higher the complexed PSA, the higher the chances
of Prostate Cancer
PSA levels correlate with stages of tumour extension and
metastases
- Advanced stages of Prostate cancer are associated
with higher PSA levels
- Organ-confined Prostate cancer has less than 50 µg/l
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PSA levels are measured in Serum
- Hence blood is collected in red top tubes for testing in
the lab
PSA in monitoring treatment
- The half-life of PSA is 2-3 days
- Levels of PSA should drop below detection limit after
Prostactomy (within 2 to 3 weeks)
Levels of PSA increase with cancer progression
Decrease in remission
Remain unchanged in stable disease