Objective: We investigated free and total prostate–specific antigen (PSA) levels and free/total (f/t) ratio in the fasting saliva and compared them with the serum levels in normal individuals, in patients with benign prostatic hyperplasia (BPH) and prostate cancer. Our aim was to determine free and total PSA and f/t ratio in saliva and to improve and simplify the differentiation between BPH and prostate cancer by using saliva as an alternative to serum.Methods: Serum and fasting saliva concentrations of free and total PSA were measured in 35 men with BPH, 16 men with stage D prostate cancer, and 25 healthy men. Serum and fasting saliva samples were collected at the same time and were analyzed on the same day at our laboratory with microparticle enzyme immunoassay technology.Results: For the total of 76 men, there was a significant correlation between free and total PSA levels in each sample (r = 0.97 for serum and r = 0.44 for saliva, p<0.001). Although there was a significant difference between three groups for serum–free and total PSA levels and serum f/t ratios, no significant difference was determined between groups for salivary free and total PSA levels and salivary f/t ratios. No correlations were found between patient age and salivary PSA levels.Conclusions: Fasting salivary free and total PSA levels are not effected by high serum levels of prostatic origin. Although there was a significant difference between mean serum and salivary levels of free and total PSA in each group, the f/t ratio of saliva was very close to the serum ratio of normal subjects. Determination of free and total PSA in saliva to improve and simplify the differentiation between prostate cancer and BPH is not suitable for use as alternative measurement of serum.

Kamoshida S, Tsutsumi Y: Extraprostatic localization of prostatic acid phosphatase and prostate–specific antigen: Distribution in cloacogenic glandular epithelium and sex–dependent expression in human anal gland. Hum Pathol 1990;21:1108–1111.
Elgamal AA, Van de Voorde W, Van Poppel H, Lauweryns J, Baert L: Immunohistochemical localization of prostate–specific markers within the accessory male sex glands of Cowper, Littre and Morgagni. Urology 1994;44:84.
Frazier HA, Humprey PA, Burchette JL, Paulson DF: Immunoreactive prostatic specific antigen in male periurethral glands. J Urol 1992;147:246–248.
Iwakiri J, Grandbois K, Wehner N, Graves HCB, Stamey T: An analysis of urinary prostate specific antigen before and after radical prostatectomy: Evidence for secretion of prostate specific antigen by the periurethral glands. J Urol 1993;149:783.
Takayama TK, Vessella RL, Brawer MK, True LD, Noteboom J, Lange PH: Urinary prostatic specific antigen levels after radical prostatectomy. J Urol 1994;151:82.
Dodson MK, Cliby WA, Keeney GL, Peterson MF, Podratz KC: Skene’s gland adenocarcinoma with increased serum level of prostate–specific antigen. Gynecol Oncol 1994;55:304– 307.
Freeman NJ, Doolittle C: Elevated prostate markers in metastatic small cell carcinoma of unknown primary. Cancer 1991;68:118–120.
Pummer K, Wirnsberger G, Purstner P, Stettner H, Wandschneider G: False–positive prostate specific antigen values in the sera of women with renal cell carcinoma. J Urol 1992;148: 21–23.
Bilgrami S, Singh NT, Shafi N, Ciesielski T: Raised prostate–specific antigen in adenocarcinoma of lung. Lancet 1994;344:1371–1372.
Papotti M, Paties C, Peveri V, Moscuzza L, Bussolati G: Immunocytochemical detection of prostate–specific antigen (PSA) in skin adnexal and breast tissues and tumors. Basic Appl Histochem 1989;33:25–29.
Van Krieken JH: Prostate marker immunoreactivity in salivary gland neoplasms. Am J Surg Pathol 1993;17:410–414.
Wilbur DC, Krenzer K, Bonfiglio TA: Prostate specific antigen (PSA) staining in carcinomas of non–prostatic origin (abstract). Am J Clin Pathol 1987;88:530.
Kuopio T, Ekfors TO, Nikkanen V, Nevalainen TJ: Acinar cell carcinoma of the pancreas: Report of three cases. APMIS 1995;103:69–78.
Yu H, Diamandis EP, Levesque M: Expression of the prostate–specific antigen gene by a primary ovarian carcinoma. Cancer Res 1995;55: 1603–1606.
Zaviacic M, Sidlo J, Borovsky M: Prostate specific antigen and prostate specific acid phosphatase in adenocarcinoma of Skene’s paraurethral glands and ducts. Virchows Arch 1993;423:503–505.
Grignon DL, Ro JY, Ayala AG, Johnson DE, Ordonez NG: Primary adenocarcinoma of the urinary bladder: A clinicopathological analysis of 72 cases. Cancer 1991;67:2165–2172.
James GK, Pudek M, Berean KW, Diamandis EP, Archibald BL: Salivary duct carcinoma secreting prostate–specific antigen. Am J Clin Pathol 1996;106:242–247.
Elgamal AA, Ectors NL, Widyapurta S, Van Poppel H, Van Damme B, Baert L: Detection of prostate specific antigen in pancreas and salivary glands: A potential impact on prostate cancer overestimation. J Urol 1996;156:464– 468.
Wang MC, Valenzuela LA, Murphy GP: Purification of a human prostate–specific antigen. Invest Urol 1979;17:159–163.
Lilja H, Christensson A, Dahlen U: Prostate–specific antigen in serum occurs predominantly in complex with alpha1–antichymotrypsin. Clin Chem 1991;37:1618–1625.
Breul J, Pickl U, Hartung R: Prostate–specific antigen in urine. Eur Urol 1994;26:18–21.
Kılıc S, Yalcınkaya S, Guntekin E, Kukul E, Deger N, Sevuk M: Determination of the site of metabolism of total, free and complexed prostate–specific antigen. Urology 1998;52: 470–473.
Breul J, Pickl U, Schaff J: Extraprostatic production of prostate specific antigen is under hormonal control. J Urol 1999;157:212–213.
Graves HC, Sensabaugh GF, Blake ET: Postcoital detection of a male–specific semen protein. Application to the investigation of rape. N Engl J Med 1985;312:338.
Breul J, Pickl U, Hartung R: Prostatic–specific antigen in urine and saliva (abstract 359). J Urol 1993;149:302A.
Kanety H, Madjar Y, Dagan Y, Levi J, Papa MZ, Pariente C, Goldwasser B, Karasik A: Serum insulin–like growth factor–binding protein–2 (IGFBP–2) is increased and IGFBP–3 is decreased in patients with prostate cancer: Correlation with serum prostate–specific antigen. J Clin Endocr Metab 1993;77:229.
de Were White RW, Meyers FJ, Soares SE, Miller DG, Soriano TF: Urinary prostate specific antigen levels: Role in monitoring the response of prostate cancer to therapy. J Urol 1992;147:947–951.
Ishikawa T, Kashiwagi H, Iwakami Y, Hirami M, Kawamura T, Aiyoshi Y, Yashiro T, Ami Y, Uchida K, Miwa M: Expression of alpha–fetoprotein and prostate–specific antigen genes in several tissues and detection of mRNAs in normal circulating blood by reverse transcriptase–polymerase chain reaction. Jpn J Clin Oncol 1998;28:723–728.
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