Extraprostatic sources of the prostate specific antigen

The studies of the last years showed, that prostate specific antigen (PSA) is not absolutely organ specific and could be detected in endometrium, in mammary gland, in breast milk, in adrenal tumors, in tumor tissue of renal cell carcinoma, in secretory epithelial cells of the trachea, thyroid gland, breast, salivary gland, jejunum and ileum, epididymis, seminal vesicles and urethra, also in Leydig cells, pancreatic cells, exocrine glands’ cells and cells of the epidermis. Clinical practice is full of the cases, when in patients with high serum PSA level primary and secondary biopsy shows no prostate cancer cells, even when a template biopsy is used. According to this data we have developed an algorithm of the surveillance for the patients with elevated PSA level. We consider, that it is necessary to perform a template biopsy, when a primary transrectal multifocal biopsy (12-16 cylinders) showed no malignant cells in a patient with constantly elevated PSA level before starting the differential diagnosis with the tumors of other organs. The absence of the tumor confirmation according to the template biopsy and constantly elevated PSA is an indication for the differential diagnosis with the tumors of other localization. The necessary investigations list is following: chest CT, mammography and breast ultrasound (US), US of the salivary, thyroid and parathyroid glands, abdominal and retroperitoneal CT, head and spine MRI and colonoscopy. When the positive results are obtained within these investigations a referral to the corresponding specialist should be done.