A New Interpretation of the Standard PSA-Test
Authors Esteban EP, Almodovar-Abreu L
Received 27 November 2019
Accepted for publication 11 February 2020
Published 2 March 2020 Volume 2020:12 Pages 75—84
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Jan Colli
Ernesto P Esteban,1 Lusmeralis Almodovar-Abreu2
1Physics Department, University of Puerto Rico-Humacao, Humacao 00791, Puerto Rico; 2Chemistry Department, University of Puerto Rico-Humacao, Humacao 00791, Puerto Rico
Correspondence: Ernesto P Esteban
Physics Department, University of Puerto Rico-Humacao, PO BOX 10100, Humacao 00792, Puerto Rico
Tel +1 787 446 6660
Background: In Puerto Rico, prostate cancer (PC) has the highest incidence and level of mortality. PC screening is performed using the standard prostatic-specific antigen (PSA) test with a cut-off value of 4.0 ng/mL. However, the standard PSA test is very controversial because it is subject to false positives and negatives.
Purpose: To establish a new interpretation of the standard PSA test based on the strong correlation between total serum PSA and tumor volume.
Patients and Methods: A PSA database of 21,980 Puerto Rican men (2004– 2015) with proven PC was provided by the Puerto Rico Cancer Center Register (PRCCR). A statistical analysis was conducted for the entire PC population divided into two categories i) age and PSA ranges and ii) diagnostic year, age ranges, and PSA ranges. The weighted first percentiles of the PSA ranges were used to define three PSA cut-off values related to small, intermediate, and large tumor volumes. Further, three baseline PSA weighted median values were calculated to enable better prognosis of PC.
Results: Three PSA cut-off values of 2.1 ng/mL, 6 ng/mL, and 10.5 ng/mL were found related to small (1.0 cc), intermediate (2.8 cc), and large (5.0 cc) PC tumor volumes, respectively. PSA values greater than the weighted median values of 3.1 ng/mL, 7 ng/mL, were associated with increased risks of tumors growing from small to intermediate and from intermediate to large size, respectively. A PSA value greater than 14.1 ng/mL was related to metastasis.
Conclusion: In this research, we have found a new interpretation of the PSA test based on PSA cut-off values correlated to small, intermediate, and large prostate cancer tumor volumes. The set of these results together with the weighted PSA median values enhance the usefulness of the standard PSA test and provide a tool for a better decision-making and treatment.
Keywords: prostate cancer, PSA, tumor volume, Puerto Rico
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