Postmortem Serum Prostate-Specific Antigen as a Potential Marker for Prostatic Disease: A Forensic Exploratory Study

INTRODUCTION: Prostate-specific antigen (PSA) is widely used clinically to diagnose and monitor prostate cancer (PCa) and benign prostatic hyperplasia (BPH). Although PSA has long been used in forensic science for semen identification, its utility as a postmortem serum biomarker has not been systematically evaluated in a forensic autopsy context. This study explored whether postmortem serum PSA levels may reflect underlying prostatic pathology in forensic autopsy practice. METHODS: A total of 101 male autopsy cases (PCa, n = 3; BPH, n = 16; non-prostatic malignancies, n = 36; controls, n = 46) examined between 2015 and 2024 were included. Postmortem cardiac blood was collected, and serum PSA levels were measured using chemiluminescent enzyme immunoassays. Group comparisons were performed using the Kruskal-Wallis test with Dunn's post-hoc analysis, and relationships between PSA levels, age, and postmortem interval (PMI) were examined using simple linear regression. RESULTS: Median PSA levels were 0.87 ng/mL in controls, 234.0 ng/mL in PCa, and 3.82 ng/mL in BPH, while PSA levels in non-prostatic malignancies were comparable to controls. Markedly elevated PSA values were observed in PCa cases compared with controls; however, all PCa-related findings were interpreted strictly as exploratory owing to the extremely small number of PCa cases (n = 3). In the BPH group, the PSA values showed only a modest tendency toward elevation relative to controls, with substantial overlap between groups. PSA levels in controls showed no significant correlation with age or PMI. CONCLUSION: Postmortem serum PSA may serve as a supportive adjunctive indicator of underlying prostatic pathology in forensic autopsies; however, its diagnostic performance - particularly for distinguishing benign disease from normal aging - appears limited. These findings should be regarded as hypothesis-generating and require confirmation in larger multicenter cohorts. The primary objective was to explore whether postmortem serum PSA differs among PCa, BPH, and control cases, and the secondary objectives were to examine its relationships with age and PMI and the postmortem stability of PSA.