Association of extent and aggressiveness of inflammation with serum PSA levels and PSA density in asymptomatic patients

OBJECTIVES The relationship between serum prostate-specific antigen (PSA) levels and histologic prostatic inflammation is controversial. Previous studies were performed using either the intensity or extent of inflammation for grading, with a relatively lower number of specimens. In our study, the inflammation was categorized more profoundly, using both the intensity and the extent of inflammation, to determine the influence of prostatic inflammation on serum PSA levels, percent free PSA (%fPSA), and PSA density (PSAD). METHODS The study included 115 patients who underwent transrectal ultrasound-guided prostate biopsy. To categorize the inflammation, a grading method that included the intensity and extent of inflammation was used. The extent and aggressiveness of inflammation were analyzed. The patients were divided into groups using five grades for the extent and four grades for the aggressiveness of inflammation. The serum PSA Levels, fPSA levels, %fPSA, and PSAD in each group were compared. RESULTS The extent of inflammation grade correlated positively with the serum PSA level (r = 0.423, P <0.001) and PSAD (r = 0.319, P = 0.001). However, a negative correlation was found between the extent of inflammation grade and %fPSA (r = -0.268, P = 0.015). The aggressiveness of inflammation grade correlated positively with the serum PSA level (r = 0.386, P <0.001) and PSAD (r = 0.341, P = 0.001) and negatively with %fPSA (r = -0.289, P = 0.03). CONCLUSIONS If the elevation of serum PSA is thought to be caused by histologic inflammation, it might prevent unnecessary repeated biopsies.