Altuğ TUNCEL, Erdem KARABULUT, Ümit TEKDOĞAN, Metin Burçin UZUN, Yılmaz ASLAN, Ali ATAN

Serum Dehydroepiandrosterone Sulfate Usage for Early Detection of Prostate Cancer in Men with Serum Prostate Specific Antigen Level between 2.5 and 4.0 ng/ml: A Pilot Study

Aims: We prospectively evaluated the diagnostic value of serum prostate specific antigen (PSA)-based diagnostic parameters and serum dehydroepiandrosterone sulfate (DHEAS) level for early detection of prostate cancer in patients with serum PSA level between 2.5 and 4 ng/ml. Materials and Methods: This study included 83 consecutive men with serum PSA levels between 2.5 and 4.0 ng/ml. All patients underwent transrectal ultrasound-guided prostate needle biopsy. Total PSA level, free/total PSA ratio, PSA density of the total volume (PSAD-TV), PSA density of the transition zone (PSAD-TZ), and serum DHEAS values were determined. Results: Seventy-four patients (89.2%) had histopathologically confirmed benign prostatic hyperplasia and the remaining (10.8%) had prostate cancer. DHEAS was a significant predictor of prostate cancer compared to free/total PSA ratio, PSAD-TV and PSAD-TZ (PDHEAS = 0.012, Pfree/total PSA = 0.326, PPSAD-TV = 0.884, PPSAD-TZ = 0.203). If the cut-off point of DHEAS was considered 1,700 ng/ml, sensitivity and specificity of DHEAS were 100% and 59.4%, respectively. This cut-off point might lead to avoiding 40.9% of unnecessary prostate biopsies. Conclusions: Serum DHEAS seems to be a reasonable marker for early detection of prostate cancer and can avoid unnecessary prostate biopsy in patients whose serum PSA level is between 2.5 and 4 ng/ml.

Anahtar Kelimeler:

Prostate cancer, prostate specific antigen, dehydroepiandrosterone sulfate

Serum Dehydroepiandrosterone Sulfate Usage for Early Detection of Prostate Cancer in Men with Serum Prostate Specific Antigen Level between 2.5 and 4.0 ng/ml: A Pilot Study

Keywords:

Prostate cancer, prostate specific antigen, dehydroepiandrosterone sulfate,

PDF

___

Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A et al. Cancer statistics, 2005. CA Cancer J Clin 2005; 55: 10-30.
Schmid H-P, Riesen W, Prikler L. Update on screening for prostate cancer with prostate- specific antigen. Crit Rev Oncol Hematol 2004; 50: 71-8. 3. Labrie F, Candas B, Dupont A, Cusan L, Gomez JL, Suburu RE et al. Screening decreases prostate cancer death: first analysis of the 1998 Quebec prospective randomized controlled trial. Prostate 1999; 38: 83-91.
Krumholtz JS, Carvalhal GF, Ramos CG, Smith DS, Thorson P, Yan Y et al. Prostate- specific antigen cut-off 2.6 ng/ml for prostate cancer screening is associated with favorable pathologic tumor features. Urology 2002; 60: 469-73. 5. Leowattana W. DHEA(S): the fountain of youth. J Med Assoc Thai 2001; 84(Suppl 2): 605-12.
Zumoff B, Levin J, Rosenfeld RS, Markham M, Strain GW, Fukushima DK. Abnormal 24- hr mean plasma concentrations of dehydroisoandrosterone sulfate in women with primary operable breast cancer. Cancer Res 1981; 41: 3360-3.
Herbert J. The age of dehydroepiandrosterone. Lancet 1995; 345: 1193-4.
Shealy CN. A review of dehydroepiandrosterone (DHEA). Integr Physiol Behav Sci 1995; 30: 308-13.
Gordon GB, Helzlsouer KJ, Alberg AJ, Comstock GW. Serum levels of dehydroepiandrosterone and dehydroepiandrosterone sulfate and the risk of developing gastric cancer. Cancer Epidemiol Biomarkers Prev 1993; 2: 33-5.
Catalona WJ, Richie JP, Ahmann FR, Hudson MA, Scardino PT, Flanigan RC et al. Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men. J Urol 1994; 151: 1283-90.
Cooner WH, Mosley BR, Rutherford CL Jr, Beard JH, Pond HS, Terry WJ et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol 1990; 143: 1146-54.
Ellis WJ, Chetner M, Preston S, Brawer MK. Diagnosis of prostatic carcinoma: the yield of serum PSA, DRE and TRUS. J Urol 1994; 152: 1520-5.
Catalona WJ, Smith DS, Ornstein DK. Prostate cancer detection in men with serum PSA concentrations of 2.6 to 4.0 ng/ml and benign prostate examination. Enhancement of specificity with free PSA measurements. JAMA 1997; 277: 1452-5.
Babaian RJ, Johnston DA, Naccarato W, Ayala A, Bhadkamkar VA, Fritsche HA Jr. The incidence of prostate cancer in a screening population with a serum prostate specific antigen between 2.5 and 4.0 ng/ml: relation to biopsy strategy. J Urol 2001; 165: 757-60.
Makinen T, Tammela TL, Hakama M, Stenman UH, Rannikko S, Aro J et al. Prostate cancer screening within a prostate specific antigen range of 3 to 3.9 ng/ml: a comparison of digital rectal examination and free prostate specific antigen as supplemental screening tests. J Urol 2001; 166: 1339-42.
Recker F, Kwiatkowski MK, Huber A, Stamm B, Lehmann K, Tscholl R et al. Prospective detection of clinically relevant prostate cancer in the prostate specific antigen range 1 to 3 ng/ml combined with free-to-total ratio 20% or less: the AARAU experience. J Urol 2001; 166: 851-5.
Djavan B, Remzi M, Schulman CC, Marberger M, Zlotta AR. Repeat prostate biopsy: who, how and when? A review. Eur Urol 2002; 42: 93-103.
Colberg JW, Smith DS, Catalona WJ. Prevalence and pathologic extent of prostate cancer in men with prostate specific antigen levels of 2.9 to 4 ng/ml. J Urol 1993; 149: 507-9.
Raaijmakers R, Blijenberg BG, Finlay JA, Rittenhouse HG, Wildhagen MF, Roobol MJ et al. Prostate cancer detection in the prostate specific antigen range of 2.0 to 3.9 ng/ml: value of percent free prostate specific antigen on tumor detection and tumor aggressiveness. J Urol 2004; 171: 2245-9.
Djavan B, Zlotta A, Kratzik C, Remzi M, Seitz C, Schulman CC et al. PSA, PSA density, PSA density of transition zone, free/total PSA ratio, and PSA velocity for early detection of prostate cancer in men with serum PSA 2.5 to 4.0 ng/mL. Urology 1999; 54: 517-22.
Akduman B, Alkibay T, Tuncel A, Bozkirli I. The value of percent free prostate specific antigen, prostate specific antigen density of the whole prostate and of the transition zone in Turkish men. Can J Urol 2000; 7: 1104-9.
Stahl F, Schnorr D, Pilz C, Dorner G. Dehydroepiandrosterone (DHEA) levels in patients with prostatic cancer, heart diseases and under surgery stress. Exp Clin Endocrinol 1992; 99: 68-70.
Comstock GW, Gordon GB, Hsing AW. The relationship of serum dehydroepiandrosterone and its sulfate to subsequent cancer of the prostate. Cancer Epidemiol Biomarkers Prev 1993; 2: 219- 21.
Hill P, Garbaczewski L, Helman P, Walker AR, Garnes H, Wynder EL. Environmental factors, hormone status, and prostatic cancer. Prev Med 1980; 9: 657-66.
Litman HJ, Bhasin S, Link CL, Araujo AB, McKinlay JB. Serum androgen levels in black, Hispanic, and white men. J Clin Endocrinol Metab 2006 Nov; 91(11): 4326-34.
Eaton NE, Reeves GK, Appleby PN, Key TJ. Endogenous sex hormones and prostate cancer: a quantitative review of prospective studies. Br J Cancer 1999; 80: 930-4.
Schatzl G, Reiter WJ, Thurridl T, Waldmüller J, Roden M, Soregi S. Endocrine patterns in patients with benign and malignant prostatic diseases. Prostate 2000; 44: 219-24.
Ozen H, Aygun C, Ergen A, Sozen S, Aki FT, Uygur MC. Combined use of prostate-specific antigen derivates decreases the number of unnecessary biopsies to detect prostate cancer. Am J Clin Oncol 2001; 24: 610-3.
Akdas A, Tarcan T, Turkeri L, Cevik I, Biren T, Gurmen N. The diagnostic accuracy of digital rectal examination, transrectal ultrasonography, prostate specific antigen and PSA density in prostate carcinoma. Br J Urol 1995; 76: 54-6.
Nadler RB, Humphrey PA, Smith DS, Catalona WJ, Ratliff TL. Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol 1995; 154: 407-13.