PSA(PROSTATE-SPECIFIC ANTIGEN)

PREP BY ABDULMALIK ABID

PROSTATE SPECIFIC ANTIGEN

 Prostate-specific antigen (PSA), also known as gamma-

seminoprotein or kallikrein-3 (KLK3), is a glycoproteinenzyme
 encoded in humans by the KLK3 gene. PSA is a member of the 
kallikrein-related peptidase family and is secreted by the epithelial cells
 of the prostate gland. PSA is produced for the ejaculate, where it
liquefies semen in the seminal coagulum and allows sperm to swim
freely. It is also believed to be instrumental in dissolving 
cervical mucus, allowing the entry of sperm into the uterus.
PSA CONT………….

 PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated
in the presence of prostate cancer or other prostate disorders.

  PSA is not a unique indicator of prostate cancer, but may also detect prostatitis or 
benign prostatic hyperplasia. 30 percent of patients with high PSA have prostate cancer diagnosed
after biopsy.
PSA CLINICAL USES

 Clinical practice guidelines for prostate cancer screening vary and are controversial due to

uncertainty as to whether the benefits of screening ultimately outweigh the risks of 
overdiagnosis and over treatment. In the United States, the U.S. Food and Drug Administration
 (FDA) has approved the PSA test for annual screening of prostate cancer in men of age 50 and
older
  PSA levels between 4 and 10 ng/mL (nanograms per milliliter) are considered to be suspicious
and consideration should be given to confirming the abnormal PSA with a repeat test. If
indicated, prostate biopsy is performed to obtain tissue sample for histopathological analysis
HISTOLOGY

 PSA is produced in the epithelial cells of the prostate, and can be demonstrated in biopsy samples or other histological specimens using 
immunohistochemistry. Disruption of this epithelium, for example in inflammation or benign prostatic hyperplasia, may lead to some
diffusion of the antigen into the tissue around the epithelium, and is the cause of elevated blood levels of PSA in these conditions.
  PSA remains present in prostate cells after they become malignant. Prostate cancer cells generally have variable or weak staining for PSA,
due to the disruption of their normal functioning. Thus, individual prostate cancer cells produce less PSA than healthy cells; the raised
serum levels in prostate cancer patients is due to the greatly increased number of such cells, not their individual activity
  However, in most cases of prostate cancer, the cells remain positive for the antigen, which can therefore be used to identify metastasis.
Since some high-grade prostate cancers may be entirely negative for PSA, however, histological analysis to identify such cases usually uses
PSA in combination with other antibodies, such as PSAP and CD57.
BIOCHEMISTRY

Prostate-specific antigen (PSA, also known as kallikrein

III, seminin, semenogelase, γ-seminoprotein and P-30
antigen) is a 34-kD glycoprotein produced almost exclusively
by the prostate gland. It is a serine protease enzyme, the gene of
which is located on the 19th chromosome (19q13) in humans
SERUM LEVELS OF PSA
 PSA is normally present in the blood at very low levels. The reference range of less than 4 ng/mL for the first
commercial PSA test, the Hybritech Tandem-R PSA test released in February 1986, was based on a study that
found 99% of 472 apparently healthy men had a total PSA level below 4 ng/mL—the upper limit of normal is
much less than 4 ng/mL.
 ncreased levels of PSA may suggest the presence of prostate cancer. However, prostate cancer can also be present
in the complete absence of an elevated PSA level, in which case the test result would be a false negative

 PSA levels can be also increased by prostatitis, irritation, benign prostatic hyperplasia (BPH), and recent
ejaculation, producing a false positive result
THE "NORMAL" REFERENCE RANGES FOR PROSTATE-SPECIFIC ANTIGEN
INCREASE WITH AGE, AS DO THE USUAL RANGES IN CANCER

Age <50 50 - 59 60 - 69 >70 (years)

No No No No
Cancer Cancer Cancer Cancer
cancer cancer cancer cancer
5th 
0.4 0.3 1.2 0.3 1.7 0.3 2.3 0.4
percentile
(ng/mL)
95th
163.0 2.5 372.5 4.7 253.2 8.3 613.2 17.8
percentile
CONCENTRATION OF PSA IN HUMAN BODY FLUIDS

Fluid PSA (ng/mL)

semen 200,000 - 5.5 million

amniotic fluid 0.60 - 8.98

breast milk 0.47 - 100

saliva 0
female urine 0.12 - 3.72

female serum 0.01 - 0.53

THANK
Y0U