Urinary PSA: a potential useful marker when serum PSA is between 2.5 ng/mL and 10 ng/mL

Authors

  • Stéphane Bolduc Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC
  • Louis Lacombe Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC
  • Alain Naud Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC
  • Mireille Grégoire Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC
  • Yves Fradet Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC
  • Roland R. Tremblay Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC

DOI:

https://doi.org/10.5489/cuaj.444

Abstract

Introduction: Our objective was to evaluate the usefulness of urinary prostate
specific antigen (PSA) in the differential diagnosis of benign prostatic hyperplasia
(BPH) and prostate cancer.

Methods: We undertook a prospective study and obtained informed consent from
170 men. They provided blood samples to measure serum PSA and 50 mL of firstvoided
urine to measure urinary PSA. Seventy-seven men were diagnosed with BPH; 42 patients had newly diagnosed prostate cancer; and 51 were selected as age-matched control subjects. Data were analyzed using Wilcoxon signed rank tests, receiver operating characteristic (ROC) curves and logistic regression.

Results: Prostate volume was 35 cm3 and 45 cm3 (p < 0.05), serum PSA was
9.7 ng/mL and 4.5 ng/mL (p < 0.001) and PSA density was 0.28 and 0.11 (p < 0.01) for prostate cancer and BPH patients, respectively. Overall, urinary PSA was not significantly different, but PSA ratio (urinary:serum) was significantly different at 6.7 and 30.6 (p < 0.001) for prostate cancer and BPH patients, respectively. A subgroup with serum PSA between 2.5 ng/mL and 10.0 ng/mL was selected and urinary PSA was significant: 52.6 ng/mL (n = 29) and 123.2 ng/mL (n = 35) (p < 0.05) for prostate cancer and BPH patients, respectively. PSA ratios were also significant (p = 0.007). ROC curves identified a cutoff for urinary PSA at > 150 ng/mL, with a sensitivity of 92.5%. When comparing
prostate cancer patients with age-matched control subjects, serum PSA, urinary
PSA and PSA ratio were different (p = 0.004).

Conclusion: Our study supports urinary PSA as a useful marker in the differential
diagnosis of prostate cancer and BPH, especially when serum PSA is between
2.5 ng/mL and 10 ng/mL. Low urinary PSA and PSA ratios point toward prostate
cancer. A urinary PSA threshold of > 150 ng/mL may be used to decrease the
number of prostatic biopsies.

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Author Biographies

Stéphane Bolduc, Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC

Louis Lacombe, Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC

Alain Naud, Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC

Mireille Grégoire, Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC

Yves Fradet, Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC

Roland R. Tremblay, Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, QC

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How to Cite

Bolduc, S., Lacombe, L., Naud, A., Grégoire, M., Fradet, Y., & Tremblay, R. R. (2013). Urinary PSA: a potential useful marker when serum PSA is between 2.5 ng/mL and 10 ng/mL. Canadian Urological Association Journal, 1(4), 377–81. https://doi.org/10.5489/cuaj.444

Issue

Vol. 1 No. 4 (2007): CUAJ November

Section

Original Research

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