Spectrum of Prostatic Lesions and Their Association with Serum PSA Levels

Abstract

Background: Prostatic diseases, encompassing Benign Prostatic Hyperplasia (BPH), prostatitis, Prostatic Intraepithelial Neoplasia (PIN) and adenocarcinoma, represent a significant cause of morbidity and mortality among ageing men. Serum Prostate-Specific Antigen (PSA) is widely used as a screening and monitoring tool, yet its correlation with diverse histological entities remains a subject of ongoing investigation, particularly in the Indian context. Methods: This prospective observational study was conducted in the Department of Pathology at a tertiary care hospital in South India over a period of eleven months (July 2025-May 2026). A total of 48 patients presenting with Lower Urinary Tract Symptoms (LUTS) and/or elevated serum PSA levels (>4 ng/mL) who Underwent Transrectal Ultrasound (TRUS)-guided prostate biopsy or transurethral resection of prostate (TURP) were included. Histopathological findings were classified according to standard criteria and serum PSA levels were correlated with the spectrum of lesions. Results: The mean age of the study population was 67.8±9.4 years.  Benign  Prostatic  Hyperplasia  (BPH)  was  the  most  common  histological  diagnosis (n = 26, 54.2%), followed by prostatic adenocarcinoma (n = 14, 29.2%), prostatitis (n = 5, 10.4%) and Prostatic  Intraepithelial  Neoplasia (PIN)  (n = 3, 6.3%).  The  mean  serum  PSA  level  for  BPH  was 7.8±3.2 ng/mL, while for adenocarcinoma it was 48.6±32.4 ng/mL. A statistically significant association was observed between higher serum PSA levels (>20 ng/mL) and prostatic adenocarcinoma (p<0.001). Among adenocarcinoma cases, Gleason score 7 (3+4) was the most frequent (n = 6, 42.9%). Conclusion: Serum PSA levels correlate significantly with the histological spectrum of prostatic lesions, with markedly elevated values strongly suggestive of malignancy. However, considerable overlap exists in the 4-10 ng/mL range, underscoring the necessity of histopathological confirmation for accurate diagnosis and management.