Factors Influencing the Prostate-specific Antigen Levels after Adjusting Age and Prostate Volume in Korean Men

Jae I Koh; Won Jae Yang; Yun Seob Song; Young Ho Park

doi:10.4111/kju.2008.49.5.411

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Koh, Yang, Song, and Park: Factors Influencing the Prostate-specific Antigen Levels after Adjusting Age and Prostate Volume in Korean Men

Original Article

Korean J Urol 2008;49(5):411-417.

Published online: 19 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.5.411

Factors Influencing the Prostate-specific Antigen Levels after Adjusting Age and Prostate Volume in Korean Men

Jae I Koh, Won Jae Yang, Yun Seob Song, Young Ho Park

From the Department of Urology, College of Medicine, Soonchunhyang University, Seoul, Korea

Received 15 February 2008 Accepted 14 April 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated the influence of the anthropometric and serological parameters on the prostate-specific antigen (PSA) levels after adjusting for age and the prostate volume in Korean men who visited a health promotion center.

Materials and Methods

From January 2004 to July 2007, among the 18,352 men (age range: 30 to 79) who visited our health promotion center for general check-ups, 1,230 (14.9%) men who wanted their prostate evaluated were included in this study. Thereafter, 151 men whose PSA level was over 4.0ng/ml, or their urinalysis revealed pyuria (＞5 white blood cells (WBCs)/high power fields (HPF)) were excluded. The data of the remained 1,079 men was then analyzed. All the men underwent transrectal ultrasonography, detailed anthropometric measurements and serological tests. The correlation of the PSA level with the various anthropometric and serological parameters was investigated.

Results

On the univariate analysis after adjusting for age and the prostate volume, the PSA level showed statistically significant positive correlation with the WBC, the red blood cell (RBC) and platelet (PLT) counts/μl, and the PSA level was negatively correlated with height, weight, the body surface area (BSA), the body mass index (BMI), γ-glutamyltransferase (GGT), and creatinine clearance (Ccr). On multivariate analysis, age, the prostate volume and the RBC/PLT counts/μl were positively correlated with the PSA level, and the BSA was negatively correlated with the PSA levels, whereas the BMI was not.

Conclusions

Irrespective of age, the prostate volume and the BSA were the independent factor influencing the PSA level, that is, the larger the BSA, the lower the PSA.

Keywords: Prostate-specific antigen, Body surface area, Body mass index

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Table 1.

Distribution of the clinical parameters

Parameters (Unit)	Mean	SD	Median	25th, 75th percentiles	IQR	5th, 95th percentiles
PSA (ng/ml)	1.16	0.71	0.98	0.69, 1.43	0.74	0.40, 2.68
Age (years)	50.7	8.2	50.0	45.0, 56.0	11.0	38.0, 65.0
Prostate volume (ml)	25.7	7.9	24.7	20.2, 29.8	9.6	15.5, 40.3
Anthropometric measurements
Height (cm)	169.9	5.7	170.0	166.0, 173.8	7.8	160.6, 179.7
Weight (kg)	70.6	9.3	70.3	64.2, 76.5	12.3	56.0, 87.2
BMI (kg/m²)	24.3	2.6	24.4	22.6, 26.2	3.6	20.0, 28.8
BSA (m²)	1.80	0.13	1.81	1.73, 1.90	0.27	1.61, 2.04
Systolic BP (mmHg)	124.6	13.4	124.0	115.0, 134.0	19.0	104.0, 147.0
Diastolic BP (mmHg)	81.7	10.2	82.0	74.0, 88.0	14.0	65.0, 99.0
Complete blood count
WBC (x10³/μl)	6.1	1.3	6.0	5.2, 7.1	1.9	4.2, 8.6
RBC (x10⁶/μl)	4.8	0.3	4.8	4.6, 5.1	0.5	4.2, 5.4
Hb (g/dl)	15.2	1.0	15.3	14.7, 15.9	1.2	13.7, 16.8
Hct (%)	44.4	2.9	44.4	42.5, 46.4	3.9	39.8, 49.4
PLT (x10³/μl)	243.2	54.0	239.0	207.0, 274.0	67.0	166.0, 338.0
Liver function tests
AST (U/l)	26.3	13.5	24.0	20.0, 29.0	9.0	16.0, 44.0
ALT (U/l)	30.0	20.7	25.0	19.0, 35.0	16.0	13.0, 62.0
ALP (U/l)	66.6	17.2	64.0	55.0, 75.0	20.0	45.0, 97.0
GGT (U/l)	42.1	55.0	30.0	20.0, 46.0	26.0	13.0, 98.0
Albumin (g/dl)	4.5	0.2	4.5	4.4, 4.7	0.3	4.2, 4.9
Bilirubin (mg/dl)	0.9	0.3	0.9	0.7, 1.1	0.4	0.5, 1.6
Renal function tests
BUN (mg/dl)	14.8	3.3	14.6	12.5, 17.0	4.5	9.8, 20.9
Cr (mg/dl)	0.9	0.1	1.0	0.9, 1.1	0.2	0.8, 1.2
Ccr (ml/min)	87.4	19.6	86.5	73.8, 99.8	26.0	55.5, 121.8
Lipid profile
Cholesterol (mg/dl)	194.7	31.2	194.0	174.0, 215.0	41.0	144.0, 248.0
Triglyceride (mg/dl)	151.1	95.3	129.0	94.0, 182.0	88.0	59.0, 310.0
LDL-C (mg/dl)	123.2	29.3	122.0	103.0, 142.0	39.0	75.0, 176.0
HDL-C (mg/dl)	50.7	11.5	50.0	43.0, 57.0	14.0	43.0, 70.0
Other constitutes
FBS (mg/dl)	101.1	22.7	96.0	90.0, 105.0	15.0	82.0, 136.0
Total protein (g/dl)	7.2	0.3	7.3	7.0, 7.5	0.5	6.7, 7.9
Sodium (mmol/l)	141.8	2.2	142.0	140.0, 143.0	3.0	138.0, 146.0
Pottasium (mmol/l)	4.1	0.3	4.1	3.9, 4.4	0.5	3.6, 4.7
Osmolarity (mol/kg)	294.6	4.7	294.5	291.5, 297.4	5.9	287.2, 302.9
CA19-9 (ng/ml)	8.8	12.8	5.5	3.2, 10.7	7.5	0.7, 27.5
AFP (ng/ml)	4.4	13.3	3.4	2.5, 4.9	2.4	1.5, 8.0
CEA (ng/ml)	1.1	0.9	0.9	0.6, 1.2	0.6	0.4, 2.4
TSH (μIU/ml)	2.5	2.8	2.1	1.4, 2.9	1.5	0.7, 5.3
Amylase (U/l)	67.3	23.7	64.0	53.0, 77.0	24.0	38.0, 106.0
Uric acid (mg/dl)	6.1	1.2	6.1	5.4, 6.9	1.5	4.1, 8.2
Calcium (mg/dl)	9.1	0.3	9.1	8.9, 9.3	0.4	8.5, 9.7

SD: standard deviation, IQR: interquartile range, PSA: prostate-specific antigen, BMI: body mass index, BSA: body surface area, BP: blood pressure, WBC: white blood cell, RBC: red blood cell, Hb: hemoglobin, Hct: hematocrit, PLT: platelet, AST: aspartate aminotransferase, ALT: alanine aminotransferase, ALP: alkaline phosphatase, GGT:γ-glutamyltransferase, BUN: blood urea nitrogen, Cr: creatinine, Ccr: creatinine clearance, LDL-C: low density lipoprotein cholesterol, HDL-C: high density lipoprotein cholesterol, FBS: fasting blood glucose, CA19-9: carbohydrate antigen 19-9, AFP: α-fetoprotein, CEA: carcinoembryonic antigen, TSH: thyroid stimulating hormone

Table 2.

The prostate volume and age-adjusted partial correlation between the PSA level and selected characteristics

Variables	PSA
Variables	r*	p-value
Height (cm)	−0.081	0.008
Weight (kg)	−0.114	＜0.001
BMI (kg/m²)	−0.086	0.005
BSA (m²)	−0.116	＜0.001
Systolic BP (mmHg)	0.008	0.804
Diastolic BP (mmHg)	0.010	0.732
WBC (x10³/μl)	0.071	0.019
RBC (x10⁶/μl)	0.064	0.036
Hb (g/dl)	0.031	0.302
Hct (%)	0.036	0.237
PLT (x10³/μl)	0.087	0.004
AST (U/l)	−0.059	0.052
ALT (U/l)	−0.041	0.176
ALP (U/l)	0.037	0.228
GGT (U/l)	−0.062	0.041
Albumin (g/dl)	0.007	0.816
Bilirubin (mg/dl)	−0.024	0.433
BUN (mg/dl)	0.027	0.368
Cr (mg/dl)	0.002	0.960
Ccr (ml/min)	−0.071	0.020
Cholesterol (mg/dl)	0.044	0.145
Triglyceride (mg/dl)	−0.030	0.320
LDL-C (mg/dl)	0.042	0.167
HDL-C (mg/dl)	0.055	0.074
FBS (mg/dl)	−0.004	0.895
Total protein (g/dl)	0.046	0.131
Sodium (mmol/l)	−0.011	0.718
Pottasium (mmol/l)	0.053	0.080
Osmolarity (mol/kg)	−0.005	0.878
CA19-9 (ng/ml)	0.039	0.197
AFP (ng/ml)	−0.048	0.116
CEA (ng/ml)	0.033	0.283
TSH (μIU/ml)	−0.030	0.327
Amylase (U/l)	0.050	0.100
Uric acid (mg/dl)	0.000	0.989
Calcium (mg/dl)	−0.029	0.342

r*: partial correlation coefficient adjusted by prostate volume and age, PSA: prostate-specific antigen, BMI: body mass index, BSA: body surface area, BP: blood pressure, WBC: white blood cell, RBC: red blood cell, Hb: hemoglobin, Hct: hematocrit, PLT: platelet, AST: aspartate aminotransferase, ALT: alanine aminotransferase, ALP: alkaline phosphatase, GGT:γ-glutamyltransferase, BUN: blood urea nitrogen, Cr: creatinine, Ccr: creatinine clearance, LDL-C: low density lipoprotein cholesterol, HDL-C: high density lipoprotein cholesterol, FBS: fasting blood glucose, CA19-9: carbohydrate antigen 19-9, AFP: α-fetoprotein, CEA: carcinoembryonic antigen, TSH: thyroid stimulating hormone

Table 3.

The multivariate linear regression model evaluating the factors correlated with the PSA level

Variables	Coefficient	p-value	VIF
Age (years)	0.012	＜0.001	1.319
Prostate volume (ml)	0.025	＜0.001	1.165
BSA (m²)	−0.649	＜0.001	1.174
RBC (x10⁶/μl)	0.140	0.019	1.145
PLT (x10³/μl)	0.001	0.014	1.014

PSA: prostate-specific antigen, BSA: body surface area, RBC: red blood cell, PLT: platelet

Table 4.

Results of the multivariates logistic regression analysis; the factors that affected the PSA level＞1.2ng/ml

Parameters (unit)	Odds ratio	95% Confidence interval for odds ratio		p-value
Age (50 years ＞, ≤)	1.437	1.101,	1.874	0.008
Prostate volume	1.875	1.445,	2.434	＜0.001
(25ml ＞, ≤)
BSA (1.8m² ＞, ≤)	0.683	0.527,	0.885	0.004
RBC (490x10⁶/μl ＞, ≤)	1.103	0.850,	1.431	0.461
PLT (240x10³/μl ＞, ≤)	1.281	0.992,	1.653	0.058

PSA: prostate-specific antigen, BSA: body surface area, RBC: red blood cell, PLT: platelet

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