A recent Japanese paper has suggested that a low white blood cell (neutrophil) count may be an independent predictor of risk for a positive biopsy and a diagnosis of prostate cancer.
This paper by Fujita et al., initially published in Prostate Cancer and Prostatic Diseases, and now reprinted in full on the Medscape Oncology web site, effectively suggests that men with a low neutrophil count and increased serum PSA level should strongly be considered for biopsy. It also implies that men with an normal or high neutrophil count and an elevated PSA level are more likely to be patients with benign prostatic hyperplasia.
Now we should be clear up front that this may be something that is particularly relevant in the Japanese ethnic population (although that seems unlikely) and that it would be helpful to see if this pattern of risk was also evident in other sets of patients. The good news is that if a low neutrophil count can be used as an independent predictor of risk for prostate cancer, such data can be extracted from the same blood sample as that drawn for a PSA test, so that no additional physical test is required to extract this information.
The “New” Prostate Cancer InfoLink hopes that this initial Japanese work can be replicated by a couple of other centers to see if their results can be replicated. We know that the relevant blood samples and related data are available at more than one major center. This test might be one more way that we could become better at limiting unnecessary biopsies among men who do not actually need to have them.
Filed under: Diagnosis, Risk | Tagged: biopsy, blood, cell, count, Diagnosis, neutrophil, risk, white |
THE "NEW" PROSTATE CANCER INFOLINK 
Conclusion from this Japanese study seems to apply well, also, to non-Japanese men. In my mid 50s I was diagnosed with prostate cancer; my PSA was 5, and WBC count 4,000; and I’m a white Caucasian.
If additional studies are done, PSA values greater than 10 ng/ml should also be included. If the number of neutrophils truly has predictive value of a positive biopsy, and we know that the higher the PSA value, the more likely a biopsy will be positive, then we would expect to see more positive biopsies as PSA values rise and the number of neutrophils falls. To test this theory, I looked at my initial blood test results from 07/08. PSA was 135.6, suggesting a high probability of a positive biopsy. However, the neutrophil count was 2,965, above the cut-off point in the article when only PSA values of 10 or less were studied (i.e. the study concluded that a positive biopsy was more likely if neutrophils were less than 2,900). In fact, my biopsy was positive. Conclusion (as you allude to): I am not Japanese!
It seems that a man’s risk for developing prostate cancer could be easily predicted on the basis of a very few cheap morpho-haematologic data: (1)low WBC count; (2) early baldness; (3) longer ring finger length.
Imagine the savings for the public health system!
Ummm … I’d like to see that clearly demonstrated in a prospective clinical trial!
:O)
I had a PSA of 3 and a below-protocol WBC. My biopsy was positive, with a Gleason score of 9 and metastases in two locations 2 years ago. I am a 69-year-old Caucasian. … I concur with the potential benefit of a clinical trial.
JD
I just had my driver’s medical for my class 2 license. WBC was 3.7, only part highlighted for being outside the norm. I am currently on ciprofloxacin (500 mg) twice daily for prostate infection so PSA was not taken at this time; it will be taken at end of June. I am 8 weeks into the antibiotics treatment and two more weeks to go. Could the lower WBC be a result of the antibiotics or could it be a signal that there is prostate cancer, and not an infection (which has been a recurring problem). Last PSA test was 0.7, but it has fluctuated in the past. I am seeing my urologist tomorrow to go over the test results. Any feedback would be appreciated.
Dear Blaine:
While there is a possibility that you have prostate cancer (especially if you are > 55 years of age), the fact that you have had a recurrent problem with prostate infections would explain fluctuations in your PSA level over time. If your “normal” PSA level when you aren’t showing symptoms of infection is 0.7 ng/ml, it seems highly likely to me that prostate cancer is not your problem, but you really need to discuss this with your doctor, who has much more information about your specific situation.
Thanks. … Plan on doing that today.