Total Prostate Specific Antigen in Prostate Cancer Screening in Hyperglycemic Individuals

  • Atilla Satir
    Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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  • Hakan Demirci
    Address for correspondence: Hakan Demirci, MD, Associate Professor, Department of Family Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, 16130, Yildirim, Bursa, Turkey.
    Family Medicine, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
    Search for articles by this author
Published:September 23, 2022DOI:



      In this study, it was aimed to investigate the reliability of total prostate-specific antigen (t-PSA) in prostate cancer screening in hyperglycemic (≥126 mg/dL) individuals.


      This research was planned as a cross-sectional retrospective study. Three hundred eleven cases which underwent biopsy with the suspicion of prostate cancer in the hospital were included in the study. Prostate cancer risk groups were categorized as low, intermediate and high. Those with fasting blood glucose (FBG) levels lower than 126 mg/dL were considered as the normoglycemia group.


      It was determined that the t-PSA measurement was higher in the patient group with cancer (P < .001). It was determined that the median t-PSA levels of the intermediate and high cancer groups were higher than the low cancer group (P < .001 and P = .001, respectively). t-PSA was found to be associated with increased cancer risk in cases with FBG <126. However, an increase in t-PSA values in cases with FBG ≥126 was not associated with increased prostate cancer. There is no relationship between FBG measurement and t-PSA measurement (rs=0.05, P = .446). In addition, it was determined that the t-PSA measurements of patients with FBG ≥126 and FBG<126 did not differ (P = .962).


      As a contribution to literature, we found that the t-PSA test lost its sensitivity in cases with plasma glucose levels above normal. Loss of sensitivity may result in underdiagnosis in prostate cancer and this, in turn, results in diagnosis of the cancer at a later stage. In the future, it may be necessary to adopt a different approach in prostate cancer screening in hyperglycemic cases.


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        • Bray F
        • Ferlay J
        • Soerjomataram I
        • et al.
        Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2018; 68: 394-424
        • Paul S
        • Ali A
        • Katare R.
        Molecular complexities underlying the vascular complications of diabetes mellitus–A comprehensive review.
        J Diabetes Complications. 2020; 34107613
        • Karlstad O
        • Starup-Linde J
        • Vestergaard P
        • et al.
        Use of insulin and insulin analogs and risk of cancer - systematic review and meta-analysis of observational studies.
        Curr Drug Saf. 2013; 8: 333-348
        • Harding J.L.
        • Andes L.J.
        • Gregg E
        • et al.
        Trends in cancer mortality among people with vs without diabetes in the USA, 1988–2015.
        Diabetologia. 2020; 63: 75-84
        • Hu Y
        • Zhang X
        • Ma Y
        • et al.
        Incident type 2 diabetes duration and cancer risk: a prospective study in two US cohorts.
        JNCI. 2021; 113: 381-389
        • Bi G
        • Yao G
        • Bian Y
        • et al.
        The effect of diabetes mellitus on prognosis of patients with non-small-cell lung cancer: a systematic review and meta-analysis.
        Ann Thorac Cardiovasc Surg. 2020; 26: 1
        • Jing C
        • Wang Z
        • Fu X.
        Effect of diabetes mellitus on survival in patients with gallbladder Cancer: a systematic review and meta-analysis.
        BMC cancer. 2020; 20: 1-8
        • Wotton CJ
        • Yeates DG
        • Goldacre MJ.
        Cancer in patients admitted to hospital with diabetes mellitus aged 30 years and over: record linkage studies.
        Diabetologia. 2011; 54: 527-534
        • Atchison EA
        • Gridley G
        • Carreon JD
        • et al.
        Risk of cancer in a large cohort of U.S. veterans with diabetes.
        Int J Cancer. 2011; 128: 635-643
        • Wright JL
        • Stanford JL.
        Metformin use and prostate cancer in Caucasian men: results from a population-based case–control study.
        Cancer Causes Control. 2009; 20: 1617-1622
        • Bansal D
        • Bhansali A
        • Kapil G
        • et al.
        Type 2 diabetes and risk of prostate cancer: a meta-analysis of observational studies.
        Prostate Cancer Prostatic Dis. 2013; 16: 151-158
        • Rousseau MC
        • Parent ME
        • Pollak MN
        • et al.
        Diabetes mellitus and cancer risk in a population-based case-control study among men from Montreal, Canada.
        Int J Cancer. 2006; 118: 2105-2109
        • Hippisley-Cox J
        • Coupland C.
        Predicting the risk of prostate cancer in asymptomatic men: a cohort study to develop and validate a novel algorithm.
        Br J Gen Pract. 2021; 71: e364-e371
        • Smith RA
        • Andrews KS
        • Brooks D
        • et al.
        Cancer screening in the United States, 2019: a review of current American Cancer Society guidelines and current issues in cancer screening.
        CA: Cancer J Clin. 2019; 69: 184-210
      1. American Cancer Society. Risk groups for localized prostate cancer. Available at: on September 13, 2022.

        • Zhu L
        • Cao H
        • Zhang T
        • et al.
        The effect of Diabetes mellitus on lung cancer prognosis: a PRISMA-compliant meta-analysis of cohort studies.
        Medicine. 2016; 95
        • Ferraro S
        • Bussetti M
        • Panteghini M.
        Serum prostate-specific antigen testing for early detection of prostate cancer: managing the gap between clinical and laboratory practice.
        Clin Chem. 2021; 67: 602-609
        • Vickers AJ.
        Redesigning prostate cancer screening strategies to reduce overdiagnosis.
        Clin Chem. 2019; 65: 39-41
        • Catalona WJ
        • Richie P
        • Ahmann FR
        • et al.
        Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6,630 men.
        J Urol. 1994; 151: 1283-1290
        • Finne P
        • Finne R
        • Bangma C
        • et al.
        Algorithms based on prostate-specific antigen (PSA), free PSA, digital rectal examination and prostate volume reduce false-postitive PSA results in prostate cancer screening.
        Int J Cancer. 2004; 111: 310-315
        • Eldred-Evans D
        • Tam H
        • Sokhi H
        • et al.
        Rethinking prostate cancer screening: could MRI be an alternative screening test?.
        Nat Rev Urol. 2020; 17: 526-539
        • Mottet N
        • Van den Bergh RCN
        • Briers E
        • et al.
        EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent.
        Eur Assoc Urol. 2021; 79: 243-262
        • Heijnsdijk EA
        • Bangma CH
        • Borràs JM
        • et al.
        Summary statement on screening for prostate cancer in Europe.
        Int J Cancer. 2018; 142: 741-746
        • Saeedi P
        • Petersohn I
        • Salpea P
        • et al.
        Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas.
        Diabetes Res Clin Pract. 2019; 157107843
        • Oesterling JE
        • Jacobsen SJ
        • Chute CG
        • et al.
        Serum prostate-specific antigen in a community-based population of healthy men: establishment of age-specific reference ranges.
        Jama. 1993; 270: 860-864
        • Koc G
        • Akgul K
        • Yilmaz Y
        • et al.
        The effects of cigarette smoking on prostate-specific antigen in two different age groups.
        Can Urol Assoc J. 2013; 7: E704
        • Gao X
        • Bao T
        • Yang H
        • et al.
        The association of metabolic syndrome and its components with serum prostate-specific antigen levels.
        Eur J Cancer Prevent. 2020; 29: 36-41