ABSTRACT
Objective: Prostate specific antigen (PSA) does not provide the high reliability and precision that is required for an accurate screening for prostate cancer (PCa). The aim of our study was to search for a simple, rapid, direct, preferably non-invasive, and highly accurate biomarker and procedure for the screening for PCa. Method: The levels of trace elements (TE) Br, Fe, Rb, Sr, and Zn were prospectively evaluated in expressed prostatic fluid (EPF). Also Zn/Br, Zn/Fe, Zn/Rb, Zn/Sr concentration ratios as well as ZnRb and (ZnRb)/Fe concentration combinations were calculated for EPF samples, obtained from 38 apparently healthy males and from 33, 51, and 24 patients with chronic prostatitis, benign prostatic hyperplasia, and PCa, respectively. Measurements were performed using an energy dispersive X-ray fluorescent (EDXRF) microanalysis. Results: It was found that in the EPF of cancerous prostates the levels of Rb, Zn, Zn/Br, Zn/Fe, Zn/Sr, ZnRb, and (ZnRb)/Fe were significantly lower in comparison with those in the EPF of normal, inflamed, and hyperplastic prostates. For example, in comparison hyperplastic with cancerous prostates p values obtained using Student’s t-test and Wilcoxon-Mann-Whitney U-test were <0.01 and <0.01, respectively. It was shown that “Sensitivity”, “Specificity” and “Accuracy” of PCa identification using these biomarkers in the EPF samples were all significantly higher than those resulting from of PSA tests in blood serum. Conclusions: The levels of TE and their combinations in EPF, obtained by EDXRF, is a fast, reliable, andnon-invasive diagnostic tool that can be successfully used by local, non- urologist physicians at the point-of-care to provide a highly effective PCa screening and as an additional confirmatory test before a prostate gland biopsy.