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How Useful Is Semen Cytology in the Non-Invasive Diagnosis of Prostate Cancer?

Introduction: Seminal cytology has been reported to show abnormal prostatic epithelial cells in up to 75% of men with prostate cancer on biopsy. We examined the practical value of seminal cytology for non-invasive diagnosis of prostate cancer in 52 unselected men undergoing prostate biopsy. Patients and Methods: Semen samples from 52 men requiring prostate biopsy were examined for cytological abnormalities and seminal prostate specific antigen (PSA) concentration measured. The findings were correlated with the biopsy results (cancer, prostatic intraepithelial neoplasia, inflammation, and normal), serum PSA, total and transitional zone prostate volume and semen volume. Prostate cancer diagnosis by transrectal ultrasound core biopsies was used as reference standard. Results: Tests on 50 patients were fully evaluable. Seminal cytology was abnormal in 13 patients (28%) showing mostly atypical prostatic cells rather than definite cancer cells. Abnormal seminal cytology had a 40% sensitivity and an 88% specificity for prostate cancer. Its sensitivity for either cancer or high-grade prostatic intraepithelial neoplasia was 34% with a specificity of 93%. Men with biopsy proven prostate cancer had a higher serum PSA (p < 0.01) and a lower seminal PSA (p < 0.05) compared to men without biopsy proven cancer. Conclusion: Seminal cytology is a simple and non-invasive test which warrants further study to determine its role as possible adjunct in diagnosing prostate cancer.