Published online Jan 31, 2006.
https://doi.org/10.4111/kju.2006.47.1.31
Elevation of Serum Prostate Specific Antigen in Subclinical Prostatitis: The Role of Pathology of Inflammation
Abstract
Purpose
We evaluated the correlation of the pathologic diagnosis, including the grade or location of the inflammation on a prostate biopsy specimen, to the serum prostate-specific antigen (PSA) level.
Materials and Methods
172 patients (the patients' PSA was ≥4ng/ml) who received prostate biopsy at our department from January 2000 to August 2003 were retrospectively studied. The pre-biopsy PSA and pathology, including the diagnoses and inflammatory patterns, were analyzed. The pathologic patterns of inflammation were divided as acute or chronic by the predominant inflammatory cell type; especially, the chronic inflammation was divided by grade or location, and then this was reviewed by 1 pathologist. Chronic Inflammation was graded as I, II or III according to the severity of inflammation. The PSA levels were compared among the grades. The presence or absence of chronic inflammation was checked in the periglandular, stromal and perivascular areas, respectively. The PSA levels were compared between the presence and absence of inflammation at each location.
Results
Among 172 patients, the number of patients with prostate cancer was 37 (21.5%), and 68 patients had only BPH (39.5%), 27 had only prostatitis (15.7%) and 40 patients had benign prostatic hyperplasia (BPH) with prostatitis (23.3%). The number of patients with any prostatitis was 67 (39.0%). The age of the patients was 68.4±8.7 years (45-91), the serum PSA was 13.30±14.38ng/ml (4.30-102.48), and the prostate size was 49.5±21.1ml (20-126). One case of BPH with prostatitis had a PSA level above 100ng/ml. Among the 67 specimens that showed prostatitis, 16 patients had histologically acute inflammation (23.9%) and 51 patients had chronic inflammation (76.1%). The PSA levels of the acute or chronic inflammation patients were 24.04±25.95ng/ml (4.46-102.48) and 9.93±4.73ng/ml (4.3-21.12, p=0.047), respectively. The PSA levels were not different among the 3 grades of chronic inflammation. In periglandular, stromal and perivascular locations, the PSA levels were not different between the presence and absence of chronic inflammation.
Conclusions
About 39% of the prostate biopsy specimens showed prostatitis. The PSA level was higher for the acute inflammation than for the chronic inflammation. However, there was no difference in PSA levels among the each of the grades or locations of chronic prostatic inflammation.
Fig. 1
Acute prostatic inflammation. Some neutrophiles are clustered in the periglandular stromal tissue (H&E, ×400).
Fig. 2
(A) Mild (grade I) chronic prostatic inflammation. A few mononuclear lymphoid cells are noted in the periglandular tissue (H&E, ×200). (B) Moderate (grade II) chronic prostatic inflammation. A moderate number of mononuclear cells are found in the periglandular and perivascular areas (H&E, ×200). (C) Severe (grade III) chronic prostatic inflammation. The periglandular tissue is infiltrated by mononuclear chronic inflammatory cells (H&E, ×200).
Fig. 3
(A) Periglandular chronic inflammation of the prostate (H&E, ×200). (B) Stromal chronic inflammation of the prostate (H&E, ×200). (C) Perivascular chronic inflammation of the prostate (H&E, ×200).
Table 1
The patients' demographic characteristics for each pathological diagnosis that was obtained from the prostate biopsy specimens
Table 2
Stratification of PSA levels for each pathological diagnosis
Table 3
PSA levels for each grade of chronic inflammation
Table 4
Comparisons of the PSA levels according to the presence or absence of chronic inflammation at each location
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