Benign Prostatic Hyperplasia and Prostate Specific Antigen

Testosterone (T) and 5α-dihidrotestosterone (DHT) play a crucial role in the prostate fetal development, growth and function. Testosterone is the most important serum androgen in the male, but the major androgen in the prostatic tissue is DHT. Benign prostatic hyperplasia (BPH) is the fourth most common disease and affects 6% of general population. Biochemical characteristics of BPH are decreased T, increased DHT and estrogen concentration, increased FGF and decreased TGF-β activity. Prostate specific antigen (PSA) is the main secretory product of the prostate gland; its synthesis largely depends on the DHT concentration in the prostatic tissue. Normal healthy prostate gland secretes 0.01-0.02 mg PSA per day, while hyperplastic prostate secretes ten times larger amounts of PSA. Secreted PSA is washed out from the urethra during voiding and can be detected in the urine (uPSA). However, the phenomenon of elevated PSA in BPH patients has always been regarded as the artifact, which complicates the diagnosis of localized prostate cancer (PCa). Nevertheless, recent studies precisely established that serum PSA ≥ 1.6 ng/mL is suggestive for BPH progression in men with prostate volume ≥ 31mL and age ≥ 62 years. In addition, urinary PSA (uPSA) concentration is significantly higher in subjects with BPH; uPSA level ≥ 150 ng/mL can be used as additional predictive parameter of BPH progression. Sažetak Testosteron (T) i 5α-dihidrotestosteron (DHT) igraju kljucnu ulogu u razvoju fetalne prostate, kao i u rastu i funkciji prostate kod odraslih osoba. Testosteron je najvažniji serumski androgen kod muskarca, ali je DHT glavni androgen u tkivu prostate. Benigna hiperplazija prostate (BHP) je danas cetvrta najcesca bolest, koja pogađa 6% ukupnog stanovnistva. Biohemijske karakteristike BHP su pad koncentracije T, a porast DHT i estrogena, kao i povecanje aktivnosti FGF i smanjenje aktivnosti TGF-β. Prostata specificni antigen (PSA) je glavni sekretorni proizvod prostate; sinteza PSA uglavnom zavisi od koncentracije DHT u tkivu prostate. Normalna zdrava prostate sekretuje 0.01-0.02 mg PSA dnevno, dok BHP sekretuje I 10 puta vece kolicine PSA. Sekretovani PSA se ispira iz uretre tokom mokrenja i može da se detektuje u urinu (uPSA). Međutim, porast PSA koji prati BHP je uvek bio smatran samo kao “artefakt”, koji otežava dijagnozu lokalizovanog karcinoma prostate (CaP). Ipak, novije studije su precizno utvrdile da PSA ≥ 1.6 ng/mL ukazuje na progresiju BHP, kod ljudi sa zapreminom prostate ≥ 31mL i staroscu ≥ 62 godine. Osim toga, koncentracija uPSA ≥ 150 ng/mL može da se koristi kao dodatni parametar progresije BHP.