World Prostate Cancer Awareness Month (November)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
Early prostate screening by routine IVD screening laboratory tests could diagnose Prostate enlargement in elderly males and also could detect early stage of prostate cancer, which is the second most common cancer and the fifth leading cause of cancer deaths in men(1). According to Johns Hopkins Medicine, 85 percent of prostate cancer cases are diagnosed before patients exhibit symptoms (2). Regular screening of prostate gland allows for early detection of prostate enlargement, enabling timely effective treatment that could prevent serious complications such as urinary retention, urinary tract infections (UTIs), bladder stones, bladder irritation, hematuria (blood in the urine), urine flow obstruction, bladder damage, Kidney impairment, erectile dysfunction, and decreased libido(3). Proactive prostate care ensures that prostate disorders could be managed well and effectively by using routine and special types of IVD laboratory tests, backed by digital rectal examination (DRE)test, Kidney Ureter Bladder (KUB) sonography, MRI or Prostate-Specific-Membrane Antigen (PSMA) PET scans(3).
CASE STUDY
A 68-year-old man was presented with complaint of difficulty in passing urine. A catheter was applied to collect urine and his laboratory test reports were as follows:
Routine Urine Examination (4)
| PARAMETER | NORMAL VALUES (OBSERVATIONS) |
| 1) Appearance: Clear | Clear |
| 2) Urine glucose: Absent | Absent |
| 3) Urine proteins: Absent | Absent |
| 4) Occult blood: Absent | Absent |
Microscopic Examination :
| PARAMETER | NORMAL VALUES (OBSERVATIONS) |
| 1) No significant findings observed | No significant detection |
Biochemistry laboratory tests :
| PARAMETER | REFERENCE RANGE (NORMAL VALUES) |
| 1) Serum urea nitrogen (SUN) : 17 mg/dl | 7–21 mg/dl |
| 2) Serum creatinine: 0.9 mg/dl | 0.6–1.2 mg/dl |
Q1. What is the probable diagnosis?
ANS: Obstruction to the excretion of urine.
No significant findings in routine urine examination and normal values of serum urea nitrogen and serum creatinine indicate that kidneys were not damaged.
Q2. Why early detection of urinary retention was not performed in this case?
ANS: The treating General practitioner (GP), did not order any specific IVD laboratory test and also some of the following tests: Digital Rectal Examination (DRE), KUB sonography, and PSMA PET Scan.
Q3. What were the consequences of late detection of ‘Prostate enlargement’ in this case?
ANS: Several complications were created by the prolonged urinary retention and the hospital ward stay, with a urinary catheter, patient suffered from occasional urinary tract infections (nosocomial infections, antibiotic resistant).
Q4. What was the probable line of treatment for this case?
ANS: Surgical removal of the enlarged part of the prostate gland.
Q5. What are the routine IVD laboratory tests for the early diagnosis of prostate enlargement?
ANS:
LABORATORY TESTS (8)
| PARAMETER | SUSPECTED PROSTATE ENLARGEMENT |
| 1) Urine volume of 24 hrs | Volume < 500 ml |
Routine urine examination :
| PARAMETER | SUSPECTED PROSTATE ENLARGEMENT |
| 2) Appearance | Reddish brown (presence of blood) |
| 3) Protein | Present |
| 4) Occult blood | Present |
| 5) Microscopic examination | Large numbers of pus cells and epithelial Cells: Urinary tract infection |
Note : Observations of Tests No 2, 3, 4 and 5 with complications related to prolonged urinary retention.
Q6. What are the specific IVD laboratory tests that have impacted the early diagnosis of prostate enlargement?
ANS:
| SPECIFIC BIOMARKERS AND HISTOPATHOLOGY (8) | SUSPECTED PROSTATE ENLARGEMENT |
| 1) Serum Prostate-specific antigen (PSA) | Increased |
| 2) Prostate tissue histopathology observations (5) | A tissue diagnosis of adenocarcinoma Indicate: Prostate cancer |
| 3) Urine Prostate cancer gene 3 (PCA3) RNA test | Increased |
Note:
(1) The test 5 can be used to decide if a repeat prostate biopsy is needed, mainly for men with a high PSA level but a previous negative biopsy.
(2) Mutations with inherited genetic factors, such as BRCA1 and BRCA2, are associated with a higher risk of prostate cancer.
(3) Serum prostatic acid phosphatase test is now replaced by PSA test.
Q7. What is the worldwide prevalence of prostate cancer?
ANS: Prostate cancer is the second most common cancer in men globally, following skin cancer and it was estimated that approximately 1,414,259 people were diagnosed with this disease worldwide (2024). The current burden of prostate cancer in India is substantia(9). The burden of prostate cancer in India is expected to rise due to growth of population, an increase in the proportion of aging males and increased life expectancy. In India prostate cancers are expected to reach 47,068 cases by 2025.
Note :
Although prostate cancer is highly prevalent, it has a relatively low mortality rate when detected and treated early.
ACKNOWLEDEMENT
My sincere thanks to Dr. Sanjay Nabar MS, HOD and Sr. Consultant of Center for Urology Department of Nanavati Hospital, Mumbai, Maharastra, India, for the valuable inputs in making this Newsletter refined and updated.
References
(1) Mayo Clinic Men’s Health Center. Arizona, Florida and Minnesota. USA
(2) John Hofkins Medicine, Baltimore–Washington, D.C.
(3) Kim EH, Larson JA, Andriole GL (2016). “Management of Benign Prostatic Hyperplasia”. Annual Review of Medicine (Review). 67: 137–151. doi:10.1146/annurev-med-063014-123902. PMID 26331999.
(4) Sarma AV, Wei JT (July 2012). “Clinical practice. Benign prostatic hyperplasia and lower urinary tract symptoms”. The New England Journal of Medicine. 367 (3): 248–257. doi:10.1056/nejmcp1106637. PMID 22808960.
(5) Peter A Humphrey. Histopathology of Prostate Cancer. Cold Spring Harb Perspect Med. 2017 Oct;7(10): a030411. doi: 10.1101/cshperspect.a030411.
(6) Laxman B, Morris DS, Yu J, Siddiqui J, Cao J, Mehra R, Lonigro RJ, Tsodikov A, Wei JT, Tomlins SA, Chinnaiyan AM (February 2008). “A first-generation multiplex biomarker analysis of urine for the early detection of prostate cancer”. Cancer Research. 68 (3): 645–9. doi:10.1158/0008-5472.CAN-07-3224. PMC 2998181. PMID 18245462.
(7) Awedew AF, Han H, Abbasi B, Abbasi-Kangevari M, Ahmed MB, Almidani O, et al. (GBD 2019 Benign Prostatic Hyperplasia Collaborators) (November 2022). “The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019”. The Lancet. Healthy Longevity. 3 (11): e754–e776. doi:10.1016/S2666-7568(22)00213-6.
(8) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
(9) 8. Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 &projection for 2025:Result from national cancer registry programme, India Indian J Med Res 2022;156: 598–607.
