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Incorrect biochemistry complicates prostate cancer management.

Iain McAuley¹, Gary Steinhoff, Michael McNeely

¹Department of Urology, Capital Health Region, Royal Jubilee Hospital, Victoria, BC, Canada.

The Canadian Journal of Urology

|May 16, 2002

Summary

Elevated prostate specific antigen (PSA) levels after surgery can be misleading due to cross-reactive antibodies. This case highlights the importance of antibody interference in PSA testing, preventing accurate prostate cancer monitoring.

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Area of Science:

* Urology
* Clinical Chemistry
* Immunology

Background:

* Prostate cancer diagnosis and monitoring rely heavily on prostate specific antigen (PSA) levels.
* Radical prostatectomy is a common treatment for localized prostate cancer.
* Postoperative PSA monitoring is crucial for detecting recurrence.

Observation:

* A patient presented with persistently elevated postoperative PSA levels (4.0 ng/mL) after radical prostatectomy for Gleason sum 6 adenocarcinoma.
* Subsequent PSA testing at a different laboratory yielded an unmeasurable result (<0.02 ng/mL).
* The discrepancy was attributed to the presence of an antibody cross-reacting with assay reagents.

Findings:

* The patient's elevated PSA readings were false positives caused by an antibody, likely against mouse immunoglobulin G (IgG).

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* This antibody interfered with the immunoassay used for PSA quantification.

* The true PSA level was undetectable, indicating no residual disease or recurrence.

Implications:

* Assays for prostate specific antigen (PSA) can be subject to interference from heterophile antibodies.
* Understanding antibody interference is critical for accurate interpretation of PSA test results in prostate cancer patients.
* Further investigation may be warranted in cases of discordant PSA levels to rule out assay interference.