United States and Canada. Cancer Epidemiol Biomarkers Prev. 1995;4:735-741.

24. Roehrborn CG, Boyle P, Gould AL, Waldstreicher J. Serumprostate-specific antigen as a predictor of prostate volume inmen with benign prostatic hyperplasia. Urology. 1999;53:581-589.

EDITORIAL COMMENT

Serum prostate-specific antigen (PSA) measurements oftenrepresent a real problem for both urologists and general practi-tioners. As a matter of fact, PSA testing for prostate cancerscreening is still a very controversial issue, having improveddiagnosis but not specific survival, and, in any case, representinga great source of emotional distress to patients heavily affectingtheir quality of life. It is also true that underestimation of totalPSA rise or of altered surrogate measures like PSA velocity maylead to the risk of missing a curable prostate cancer, which maycost life in case of delayed diagnosis.

The present article demonstrates that, in a general Asianmale population, PSA increases by 0.3 ng/mL and prostaticgland volume by about 3 mL every 10 years, regardless of thepresence or absence of lower urinary tract symptoms. Prostaticvolume and its derivative PSA density may well be notparticularly relevant to prostate cancer diagnosis, as alreadywidely demonstrated in the recent literature. On the otherhand, PSA velocity in individuals with normal total PSAvalues may be a valid aid to an absolutely early detection ofprostate cancer in order to plan an effective therapeutictreatment of a biochemical, really initial, and totally asymp-tomatic disease.

The knowledge of the average total PSA concentrations andof the behavior of a biological marker such as PSA in a definiteethnic/racial group is a further relevant aspect of this study,becoming even more important if we take into account thecurrent huge migratory flows and the consequent environmentalchanges, depending upon dietary factors, drinking waterfeatures, air pollution, and lifestyle.

UROLOGY 82 (6), 2013

With their results, the authors confirm that the publisheddata obtained in Western countries are similar in Asia as well,providing additional parameters depending not only uponenvironment, as previously mentioned, but also upon humanbiotypes (without forgetting the correlation between weight andmean PSA concentrations).In the present work, PSA levels and prostatic gland volume

maintain a good correlation when International ProstateSymptom Score is <20 and total PSA is <4 ng/mL. Suchcorrelation is lost in case International Prostate Symptom Scorescore >20 and PSA >4 ng/mL. The main responsibility for thisdiscrepancy is probably prostatic inflammation, an emergingrelevant variable able to affect both normal PSA levels and PSAkinetics (and possibly playing a role in prostatic carcinogenesisin the long run). The role of prostatic inflammation and of itsfeatures has been interestingly highlighted in a pre-PSA article,1

demonstrating the existence of prostatic inflammation in benignprostatic hyperplasia, the definition of its extent, and thecharacteristics of its cellular composition. Because all thepatients of the series underwent operations for benign prostatichyperplasia associated with lower urinary tract symptoms, it islikely that a percentage of the voiding symptoms were due to orworsened by phlogosis. The epidemiological data from thisKorean work may help to start to clarify the role of prostaticinflammation in an otherwise healthy population, not stratifiedupon lower urinary tract symptoms.

Roberto Mario Scarpa, M.D., Universit�a di Torino - A.O.U.San Luigi, Clinica Urologica, Orbassano (TO), Italy

Reference

1. Kohnen PW, Drach GW. Patterns of inflammation in prostatichyperplasia: a histologic and bacteriologic study. J Urol. 1979;121:755-760.

http://dx.doi.org/10.1016/j.urology.2013.07.073UROLOGY 82: 1399, 2013. � 2013 Elsevier Inc.

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