CONSTITUTIVE EXPRESSION OF HIGH-LEVELS OF PROSTATE-SPECIFIC ANTIGEN IN THE ABSENCE OF PROSTATE CARCINOMA

Objectives. To identify distinguishing serologic features in patients with stable marked elevation in prostate-specific antigen (PSA) and mu ltiple negative biopsies. Methods. The study population consisted of 7 patients with a stable PSA level of greater than 20 ng/mL (average 27 .0), followed for at least 54 months (average 56), and with two or mor e negative prostatic biopsies including transition zone biopsies. The PSA density (PSAD), rate of change in PSA, reverse transcriptase/polym erase chain reaction (RT/PCR), and free/total PSA were obtained. Resul ts. Rate of change in PSA level was stable (0.18+/-1.2 ng/mL/yr), sugg esting that there was no occult cancer; PSAD was high (0.34+/-0.5 ng/m L/cc), indicating that prostate size was not the sole cause of the ele vation. The RT/PCR was negative in 6 of 7 patients, further decreasing the likelihood of an occult malignancy. Free versus total PSA was not consistent, averaging 16.8%, but with a range of 6% to 34%. Conclusio ns. Novel PSA tests were not found to be useful in this cohort of pati ents with multiple negative biopsies and PSA elevations greater than 2 0 ng/mL. Additional studies with larger sample size are required to co nfirm this finding. Copyright 1996 by Elsevier Science Inc.