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Advanced prostate cancer with normal serum prostate-specific antigen values

R J Cohen1, Z Haffejee, G S Steele

  • 1Department of Anatomical Pathology, Medical School, South African Institute for Medical Research, Parktown.

Archives of Pathology & Laboratory Medicine
|November 1, 1994
PubMed
Summary

Advanced prostate cancer typically shows high prostate-specific antigen (PSA) levels. However, this study identified eight advanced prostate cancer cases with normal PSA, highlighting potential diagnostic challenges and the need for further investigation.

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Area of Science:

  • Urology
  • Oncology
  • Pathology

Background:

  • Prostate-specific antigen (PSA) is a key biomarker for prostate cancer detection and monitoring.
  • Elevated serum PSA levels are commonly observed in patients with advanced prostate cancer (stages C and D).

Purpose of the Study:

  • To investigate cases of advanced prostate cancer presenting with normal serum PSA levels.
  • To analyze the histological subtypes and immunohistochemical characteristics of these unusual cases.

Main Methods:

  • Retrospective analysis of 976 advanced prostate cancer cases over 45 months.
  • Serum PSA level determination at presentation.
  • Immunohistochemical assessment of tumor tissue using monoclonal and polyclonal antibodies.

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Main Results:

  • Eight cases (0.8%) of advanced prostate cancer exhibited normal serum PSA levels.
  • Histological examination revealed invasive moderately differentiated acinar carcinoma in six cases, small-cell carcinoma in one, and cribriform carcinoma in one.
  • Monoclonal antibodies showed limited staining in seven of the eight cases, whereas polyclonal antibodies demonstrated positive staining in all but the small-cell carcinoma case.

Conclusions:

  • Normal serum PSA levels can occur in a subset of patients with advanced prostate cancer, including various histological subtypes.
  • Immunohistochemical staining patterns, particularly with polyclonal antibodies, may aid in diagnosing these cases.
  • These findings underscore the importance of considering alternative diagnostic approaches when PSA levels do not align with clinical suspicion for advanced prostate cancer.