PSA level varies with frequency of sexual activity & bicycling
while MRI remains constant.

[Summary in German]

Abstract
Total PSA (prostate specific antigen) concentration, tPSA, is used alone or in combination with other parameters to predict prostate cancer (Pca) before biopsy. In principle, the quality of the test might be considerably reduced when tPSA varies to a large extent with sexual activity/bicycle riding (large as compared to the tPSA variation due to prostate cancer). Therefore the extent of this variation needs to be determined before the tPSA test for prostate cancer can be evaluated.

This activity induced tPSA variation is quantified in a man during his age interval 64 to 68. Two MRI (magnetic resonance images) taken 3 years apart and FNAB (Fine Needle Aspiration Biopsy with DNA-ploidy analysis) found no prostate cancer in this man.

Results

Fig. 1a Fig. 1b Fig. 1c Fig. 1d

Figure 1: Total PSA level (tPSA) (history and labs) of a man, age 64 at month 63, is correlated with frequency of sexual activity or extended bicycling, represented by density of vertical blue lines: tPSA falls when line density decreases below 1 line per week (light blue areas). (tentative model to factor out sexual activity)

• tPSA data points are arbitrarily connected by straight lines, except the ones in months 117 - 121 representing measurements by 2 additional labs, Bio-Labor Hemer (2 blue points next to letter H) and Labor 28 (green point right of number 28).
• Error bars (heavy black line attached to a tPSA level)): Standard deviation = +- 0.2 ng/mL, calculated from the coefficient of variation of the measurement of the total PSA level = less than 3 % (Labor 28, Angaben zur Messunsicherheit).
  
• Vertical blue lines mark days with sexual activity or extended bicycling.
• "no activity data": No sexual activity/bicycling data log was kept between months 69 and 72 and months 91 and 102.
• light blue areas: periods with subthreshold sexual activity/bicycling (i.e. less than once per week. Note: For the purpose of orientation 5 dots in the left or right hand lower corner of the diagrams are spaced 1 week apart).
  1. tPSA generally falls during those subthreshold activity periods.
  2. tPSA rises during periods with above threshold activity.
  3. tPSA gradient (change with time, also called "tPSA velocity") seems to depend on level of previous activity as represented by density of lines and duration of activity (thickness of line).
• 2 short vertical lines close to each other ("doublett") around month 90 and 1 short vertical line at month 124
  1. MRI done at time marked by left line of line doublett and line at month 124 (details below).
  2. DNA-ploidy analysis done at time marked by right line of line doublett (details below).
• Gray straight line with slope 0.75 ng/mL per year represents the threshold PSA level gradient ("PSA velocity") after Coakley FV, Chen I, Qayyum A, Westphalen AC, Carroll PR, Hricak H, Chen MH, Kurhanewicz J. Validity of prostate-specific antigen as a tumour marker in men with prostate cancer managed by watchful-waiting: correlation with findings at serial endorectal magnetic resonance imaging and spectroscopic imaging. BJU Int. 2007 Jan;99(1):41-5 (more).
• see also "biological tPSA variation of up to 20-30% in the tPSA range 0.1-20 ng/ml" in: Soeletormos G et al., "Biological variation of total prostate-specific antigen: A survey of published estimates and consequences for clinical practice", Clin. Chem 51: 1342-1351, 2005

The plots above indicate a variation of tPSA with the level of sexual activity/bicycling:

1. When a gap 1 week or longer follows a period of higher activity, then tPSA tends to fall. In the figures such gaps are shown in light blue.
2. tPSA relaxation time seems to depend on the degree of activity: After high activities (Fig. 1d) tPSA needs more time for a decrease by 1 ng/ml than after medium activities (Figs. 1 b, c).

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APPENDIX

Magnetic Resonance Images
made at times June 18, 2007 and April 23, 2010 marked by left line near month 90 and line near month 124 in figures above
D. Beyersdorff, T. Elgeti, B. Hamm

Why diagnosing with MRI?

D. Beyersdorff, A. Winkel, B. Hamm, S. Lenk, S.A. Loening, 2005 "MR Imaging-guided Prostate Biopsy with a Closed MR Unit at 1.5 T: Initial Results" (in cache), Radiology. 2005 Feb;234(2):576-81. Epub 2004 Dec 22.

Technik

MRT mit der kombinierten Endorektal-Körper-Phased-Array-Spule bei 1.5 Tesla. Lokalisationsscan,

Source: Wikipedia

axiale T1-weighted TSE, coronare T2-weighted TSE, axiale PD-weighted TSE.

Transverse and coronal T2-weighted images were evaluated for hypointense regions in the peripheral zone of the prostate.

QuickTime movies showing the stacks of layers of my transverse and coronal Magnetic Resonance Images (layer thickness: 3 mm, interlayer gap = 0.3 mm, field of view: 16 cm):

Transverse T1-weighted turbo SE sequence t1_tse_tra.mov, repetition time/echo time = 740 msec/13 msec; echo train length = 3 msec (?) (2.4 MB) Transverse T2-weighted turbo SE images T2_tse_tra.mov, repetition time/echo time = 4660 msec/100 msec; echo train length = 7 msec (?) (2.9 MB) PD_tse_tra_512.mov, (repetition time/echo time = 2260 msec/100 msec; echo train length = 7 msec (?) (1.1 MB) Coronal T2-weighted turbo SE images (repetition time/echo time = 4000 msec/100 msec; echo train length = 7 (?)) T2_tse_cor.mov (2.7 MB)

QuickTime Player Free Download Literature on Magnetic Resonance Imaging

Schematic of Prostate Zones - Coronal View
(Source: Beyersdorff D et al, Magnetic resonance (MR), Patients with a History of Elevated Prostate-Specific Antigen Levels and Negative Trtansrectal US-guided Quadrant or Sxtant Biopsy Results: Value of MR Imaging", in cache), Radiology. 2002 Sep;224(3):701-6)

T2-weighted transversal image #13 (total stack of layers: T2_tse_tra.mov) Example MR images from a different patient

T2-weighted coronal image #11 (total stack of layers: T2_tse_cor.mov)

Findings 18. June 2007 Prostate as a whole is enlarged. The zonal structure is intact. The central zone is enlarged to a small extent as part of a BPH (Benign Prostate Hyperplasia). In the peripheral zone the T2-weighted image showed low signal intensity areas right laterally left dorsobasally In the T1-weighted image no signal-intense formations are delineable. No indication of growth exceeding the capsula. No infiltration into the seminal bladders, the urinal bladder or the rectum. No indication of pathologially enlarged pelvic lymph nodes. Little free pelvic liquid. Summary 18. June 2007 Together with a Benign Prostate Hyperplasia we find moderately cancer suspicious areas (grade 3 ... 4 on a scale from 1 (insignificant) to 6 (highly significant)). They show up (1) right laterally (2) left dorsobasally. These might be targeted in a biopsy. No enlarged lymph nodes suspicious for metastasis. Little free liquid, pelvic anamnesis?

Befund 18.6.2007 Die Prostata ist insgesamt vergrößert. Die zonale Gliederung ist intakt. Die zentrale Zone ist im Sinne einer BPH (Benigne Prostata-Hyperplasie) gering vergrößert. In der peripheren Zone zeigen sich im T2-weighted Bild signalarme Veränderungen rechts lateral und links dorsobasal. Im T1-weighted Bild keine signalreichen Formationen abgrenzbar. Kein Anhalt für ein kapselüberschreitendes Wachstum. Keine Infiltration in die Samenblasen, die Harnblase oder das Rektum. Kein Nachweis pathologisch vergrößerter Lymphozytenknoten pelvin. Geringe freie Flüssigkeit pelvin. Zusammenfassende Beurteilung 18.6.2007 Bei Zeichen einer benignen Prostatahyperplasie finden sich mäßig tumorsuspekte Areale (Grad 3 ... 4 auf einer Skala von 1 (unbedeutend) bis 6 (sehr bedeutend)). Sie lassen sich rechts lateral und links dorsobasal nachweisen. Diese sollten bei einer Biopsie ggf. gezielt berücksichtigt werden. Keine metastasensuspekt vergrößerten Lymphknoten. Gering freie Flüssigkeit, pelvin Anamnese? Befund 26.4.2010 Voraufnahmen vom 18.6.2007 zum Vergleich. Die Prostata ist insgesamt vergrößert. Die zonale Gliederung ist intakt. Die zentrale Zone ist im Sinne einer BPH gering vergrößert. In der peripheren Zone zeigen sich beidseitig zwischen mittlerer Höhe und Basis T2-weighted heterogene bis hypointense Veränderungen, größtenteils zystisch-knotig imponierend, mit geringer Betonung rechts lateral und links dorsobasal. Befund in weitestgehender Konstanz zur Voruntersuchung. Im T1-weighted Bild in entsprechender Lokalisation keine signalreichen Formationen. Weitere Befunde: Harnblase mit geringer trabekulärer Betonung, ansonsten unauffällig. Samenblasen und Rektum unauffällig. Kein Nachweis pathologisch vergrößerter Lymphknoten pelvin. Aktuell allenfalls minimale freie Flüssigkeit prärektal. Konstant ovaläre zystische Läsion am ventralen Übergang Femurkopf/-hals, in erster Linie einer transkortikalen Synoviaherniation entsprechend, und kleines (max. 8 mm) Sklerasierungsareal rechts iliacal. Dorsale Bandscheibenprotrusionen bei LWK3/4-5/SWK1, bei 3/4 DD kleiner Prolaps, hier zudem Osteochondrose. Zusammenfassende Beurteilung 26.4.2010 Im Wesentlichen konstantes Bild einer benignen Prostatahyperplasie mit Strukturstörungen in der peripheren Zone, die aber, nach negativer Stanzbiopsie und weitestgehender Konstanz seit 2007, in erster Linie als unspezifisch, z.B. postentzündlich oder bei chronischer Prostatitis zu werten sind. Somit ergibt sich aktuell MR-morphologisch kein Anhalt für ein Prostata-Carcinoma. NB: Mäßig ausgeprägte Balkenblase.

Fine Needle Aspiration Biopsy and DNA-Ploidy Analysis
made at time July 25, 2007 marked by right line near month 90 in figures above
H. Al-Abadi

Cytological Assessment right: 2 samples with sufficient cell material, many larger or smaller regularly structured prostata epithelium agglomerates having uniform nuclei and regular nuleus-plasma relation. Foci of round cell infiltrates consisting predominantly of granulocytes, lymphocytes, and histiocytes (macrophagi). left: 2 samples with sufficient cell material, many larger or smaller regularly structured prostata epithelium agglomerates having uniform nuclei and regular nuleus-plasma relation. Left lateral: Clear signs of inflammation with predominantly granulocytes and lymphocytes. Summary Prostate epithelium agglomarates typical for hyperplasia. Chronic recurrent inflammation, in particular left laterally, no indication of malignancy.

Zytologische Begutachtung Rechts: Bei ausreichendem Zellmaterial aus 2 Ausstrichpräparaten erkennt man zahlreiche größere und kleinere, regelrecht strukturierte Prostataepithelverbände mit uniformen Kernen und regelhafter Kernplasmarelation. Herdförmig finden sich schüttere runde Zellinflitrate überwiegend aus Granulozyten, Lymphozyten und Histiozyten. Links: Bei ausreichendem Zellmaterial aus 2 Ausstrichpräparaten erkennt man zahlreiche, regelrecht strukturierte, größere und kleinere Prostataepithelverbände mit uniformen Kernen und regelhafter Kernplasmarelation. Links lateral: Hier erkennt man zusätzlich eine deutliche Entzündungsreaktion überwiegend aus Granulozyten und Lymphozyten. Zusammenfassende Begutachtung Es handelt sich hier um unauffällige Prostataepithelverbände im Sinne der Hyperplasie, mit einer chronisch rezidivierenden Entzündungsreaktion, besonders linkslateral, ohne Anhalt für Malignität.

Image Cytometry Prostate epithelia were stained (Feulgen reaction) and analyzed. Quantitative image cytometry analysis of the cells showed a diploid DNA histogram with a DNA index 1.00 which corresponds to the norm.

Bildzytometrische Begutachtung Die beschriebenen Prostataepithelien wurden nach Umfärben mit der Feulgenreaktion DNA-zytometrisch untersucht. Die quantitative bildzytometrische DNA-Analyse der Zellen ergab ein diploides DNA-Histogramm mit einem DNA-Index von 1.00 und entspricht der Norm.