Prostate-specific antigen test in diagnostic evaluation of chronic prostatitis/chronic pelvic pain syndrome

• Published in: Urology (Ridgewood, N.J.) Vol. 67; no. 2; pp. 337 - 342
• Main Authors: Nadler, Robert B., McNaughton Collins, Mary, Propert, Kathleen J., Mikolajczyk, Stephen D., Knauss, Jill S., Landis, J. Richard, Fowler, Jackson E., Schaeffer, Anthony J., Alexander, Richard B.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2006; Elsevier Science
• Subjects: Biological and medical sciences; Biomarkers - blood; Chronic Disease; Humans; Male; Medical sciences; Nephrology. Urinary tract diseases; Pelvic Pain - blood; Prostate-Specific Antigen - blood; Prostatitis - blood; Syndrome; Evaluation; Nephrology; Urinary system disease; Prostate disease; Exploration; Tumoral marker; Pelvic pain; Syndrome; Urology; Prostate specific antigen; Chronic; Test; Prostatitis; Diagnosis; Male genital diseases
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2005.08.031

To determine whether prostate-specific antigen (PSA), the percent free PSA, or free PSA isoforms may be used as diagnostic markers for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS; National Institutes of Health category IIIa and IIIb). We evaluated 421 patients enrolled in the Chronic Prostatitis Cohort Study and 112 age-matched controls. Subjects were stratified by the number of white blood cells (WBCs) in their expressed prostatic secretions and pain as determined by the National Institutes of Health Chronic Prostatitis Symptom Index. Total PSA, free PSA, and [−2]proPSA ([−2]pPSA) were significantly elevated in those with CP/CPPS compared with controls (mean PSA 1.97 ng/mL versus 1.72 ng/mL, P = 0.03; mean free PSA 0.76 ng/mL versus 0.70 ng/mL, P = 0.01; and [−2]pPSA 2.38 ng/mL versus 1.80 ng/mL, P = 0.04). The percent free PSA was not significantly different between the patients and controls. For those with CP/CPPS, the percent free PSA was significantly lower as the WBC count rose in the expressed prostatic secretions (0 WBCs = 43.29 versus more than 25 WBCs = 26.52; P <.0001). A PSA level of 4.0 ng/mL or greater was found in 10% of patients and 7% of controls ( P = 0.03). Men with elevated PSA values and CP/CPPS should be treated as one would any other patient screened for prostate cancer with an elevated PSA level. Although PSA, free PSA, and [−2]pPSA were slightly elevated in men with CP/CPPS, the low sensitivity and specificity do not warrant using them as biomarkers for CP/CPPS.