Histopathological Patterns of Prostatic Lesions with Serum PSA Correlation

Abstract

Background: Prostatic lesions are among the most common pathological conditions affecting elderly males. Benign prostatic hyperplasia (BPH), prostatitis, prostatic intraepithelial neoplasia (PIN), and carcinoma prostate constitute the majority of prostatic diseases. Serum prostate-specific antigen (PSA) is widely used as a biomarker for screening, diagnosis, and monitoring of prostatic disorders; however, elevated PSA levels may occur in both benign and malignant conditions.
Aim: To evaluate the histopathological patterns of prostatic lesions and correlate them with serum PSA levels.
Methods: A prospective observational study was conducted at Rabindranath Tagore Medical College, Udaipur, Rajasthan, from February 2024 to February 2026. A total of 180 patients presenting with lower urinary tract symptoms underwent serum PSA estimation and histopathological evaluation of prostatic tissue obtained by TURP, needle biopsy, or prostatectomy. Histopathological findings were correlated with serum PSA levels.
Results: Benign prostatic hyperplasia was the most common lesion (62.2%), followed by BPH with prostatitis (16.1%), prostatic adenocarcinoma (15.6%), and PIN (6.1%). Mean PSA levels were significantly higher in malignant lesions (42.8 ± 18.6 ng/mL) compared with benign lesions (8.6 ± 5.4 ng/mL) (p<0.001). PSA levels >20 ng/mL demonstrated a strong association with malignancy (p<0.001).
Conclusion: BPH remains the predominant prostatic lesion; however, significantly elevated PSA levels are strongly associated with prostatic carcinoma. Histopathological examination remains the gold standard for definitive diagnosis and should be interpreted alongside serum PSA levels.