Postmortem Serum Prostate-Specific Antigen as a Potential Marker for Prostatic Disease: A Forensic Exploratory Study

Area of Science:

• Forensic Pathology
• Biochemistry
• Oncology

Background:

• Prostate-specific antigen (PSA) is a key biomarker for prostate cancer (PCa) and benign prostatic hyperplasia (BPH).
• While used for semen identification, PSA's role as a postmortem serum biomarker in forensic autopsies is underexplored.
• This study investigates postmortem serum PSA levels to assess underlying prostatic pathology.

Purpose of the Study:

• To explore differences in postmortem serum PSA levels among prostate cancer (PCa), benign prostatic hyperplasia (BPH), and control cases.
• To examine the relationship between postmortem serum PSA levels, age, and postmortem interval (PMI).
• To evaluate the postmortem stability of PSA.

Main Methods:

• Analysis of 101 male autopsy cases (PCa, BPH, non-prostatic malignancies, controls).
• Measurement of serum PSA levels using chemiluminescent enzyme immunoassays from postmortem cardiac blood.
• Statistical analysis including Kruskal-Wallis test, Dunn's post-hoc analysis, and simple linear regression.

Main Results:

• Median PSA levels varied significantly: controls (0.87 ng/mL), BPH (3.82 ng/mL), and PCa (234.0 ng/mL).
• PCa cases showed markedly elevated PSA, though numbers were very small (n=3).
• BPH cases showed a modest PSA elevation with significant overlap with controls; PSA levels did not correlate with age or PMI in controls.

Conclusions:

• Postmortem serum PSA can be a supportive indicator of prostatic pathology in forensic settings.
• Diagnostic performance for distinguishing benign conditions from normal aging is limited.
• Findings are hypothesis-generating, necessitating validation in larger, multicenter studies.