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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 10-13

Level change of prostate-specific antigen in patients with benign prostatic hyperplasia after transurethral prostatic resection


1 Department of Urology, The First Affiliated Hospital of Medical University, Liaoning, Shenyang 110001, China
2 Department of Orthopedics, Qidong People's Hospital, Jiangsu, China

Date of Web Publication1-Mar-2017

Correspondence Address:
Chuize Kong
Department of Urology, The First Affiliated Hospital of China Medical University, Liaoning, Shenyang 110001
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2394-2916.201276

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  Abstract 

Objectives: The objective of this study was to explore the values of prostate-specific antigen (PSA) before and after transurethral prostatic resection (TURP) surgery and the corresponding correlation with the resection extent through short and long-term changes of benign prostatic hyperplasia (BPH) of patient's serum PSA after TURP. Materials and Methods: Data were abstracted from a retrospective sampling study of 209 cases of BPH patients. The values of serum PSA level were measured preoperatively and at specified periods after TURP surgery; 5 days, 1 month, 3 months, and 6 months. These periods were correlated with the resection extent. Results: Quantitative PSA values were collected before and after the surgical procedure at the time periods. The decrease of PSA value was observed 5 days after surgery when compared with preoperative PSA value, which is about 4.42 ± 8.78 ng/mL while 35% decrease was reported following a month after surgery. Moreover, PSA levels in these five periods were significantly different (P < 0.01), and the value of PSA >4 ng/mL group is still higher than the group of PSA ≤4 ng/mL after the decrease. Resection extent of TURP: The mean differences between real removal quality and the quality, according to the prostate ultrasonography, should be removed, which is expressed in ± standard deviations. The value of the total sample is −0.941 ± 9.56 ng/mL. Values in the group of PSA ≤4 ng/mL and PSA >4 ng/mL are 0.13 ± 10.53 and −3.83 ± 5.41, respectively. There appears to be a positive correlation between the variations of PSA and the resection extent (P < 0.01, R = 0.91). In addition, a positive correlation was confirmed between the variations of PSA and the resection extent in the group of PSA ≤4 ng/mL and PSA >4 ng/mL (P < 0.01, R 1 = 0.986, R 2 = 0.924). Conclusion: A downward trend is demonstrated here in PSA after TURP. The PSA value lowered to a normal level in about 1 month. The interesting point is that there is an inverse relationship between the larger size of the resection and the decrease in PSA values. Thus, missed and misdiagnoses of prostate cancer could be reduced with the long-term follow-up of BPH patients' postoperative levels of serum after TURP. In regards to patients whose preoperative PSA >4 ng/mL, monitoring standards should be taken according to their postoperative PSA baseline when measuring their results of prostate needle biopsies and the diagnosis of prostatic cancer.

Keywords: Benign prostatic hyperplasia, prostate-specific antigen, resection size, transurethral prostatic resection


How to cite this article:
Liu J, Tang J, Gong D, Kong C. Level change of prostate-specific antigen in patients with benign prostatic hyperplasia after transurethral prostatic resection. J Integr Nephrol Androl 2017;4:10-3

How to cite this URL:
Liu J, Tang J, Gong D, Kong C. Level change of prostate-specific antigen in patients with benign prostatic hyperplasia after transurethral prostatic resection. J Integr Nephrol Androl [serial online] 2017 [cited 2017 Oct 19];4:10-3. Available from: http://www.journal-ina.com/text.asp?2017/4/1/10/201276


  Introduction Top


Prostate-specific antigen (PSA) is a type of glycoprotein, the relative molecular mass of which is 33 ~34 kDa. It is produced in the epithelial cell of the prostate glandular tube. Normal PSA is located mainly on the epithelia of peripheral zone and central zone, that is specific to prostate tissue.[1]

It is now considered the most significant and accurate diagnostic marker for prostate neoplasm. In recent years, numerous articles report that due to benign prostatic hyperplasia (BPH), patient's serum PSA had changed dramatically after transurethral prostatic resection (TURP). However, limited reviews can be found on the influence of resection size on serum PSA of patients with BPH after TURP and whether PSA can be normally expressed by hyperplasic prostatic epithelium.[2]

To study PSA's magnitude of changes and influencing factors, we analyzed the changes of serum PSA levels before and after surgery of patients with BPH by TURP surgery.


  Materials and Methods Top


Clinical data

Prostate puncture biopsy was performed in 209 cases with indications of prostate needle biopsies (PSA >4 ng/mL) in the Department of Urology, The First Affiliated Hospital of China Medical University, from January 2011 to January 2012.

Exclusion criteria

Patients with neurogenic bladder, acute bacterial prostatitis, prostatic cancer, prostatic cancer after BPH, bladder tumor, bladder stone, and other diseases were ruled out after close examination. In addition, neither of these patients had a history of acute urinary retention in the last 3 months nor did they take any systematic treatment for patients.

Patients were divided into two groups according to their PSA preoperatively: PSA >4 ng/mL (84 cases) and PSA ≤4 ng/mL (125 cases).

Blood samples were taken the next morning, after they were admitted to hospital, without receiving prostatic massage, puncture biopsy of the prostate, urethral catheterization, urethral dilatation, cystoscopy, or rectal touch. Immediately, their blood samples were sent to the clinical laboratory to determine serum PSA.

Detection methods

TURP surgery was performed in all these cases as well as comprehensive rehabilitation therapy including 5 days of indwelling catheter after operation, anti-inflammatory therapy, bladder irrigation, hemostasis, maintaining the balance of electrolyte, etc. Blood samples were sent to the clinical laboratory to determine serum prostate-specific antigen 5 days, 1 month, 3 months, and 6 months after surgery.

Prostate volume formula = left and right diameter × upper and lower diameter × anteroposterior diameter × 0.523.

Prostate gland weight formula = volume × 1.05.[3]

Normal prostate diameter around 4 cm, longitudinal diameter around 3 cm, weight 18–20 g.

The formula for weight should be removed = Gland weight −20 g.

The difference between the actual surgical resection of the weight and the weight should be removed is the degree of resection; the smaller the difference, the more thorough resection.

Statistical analysis

Data were analyzed by the SPSS for windows 13.0 statistical analysis software (SPSS Inc., Chicago, IL). The difference of measurement datum was compared with an independent sample t-test between the two groups. The changes of PSA, both pre- and post–surgery, were compared by paired sample t-tests. Pearson's correlation was used in analyzing the impact of the resection extent to the declination of PSA. The difference was statistically significant when P < 0.05.


  Results Top


Patients' age ranged from 49 to 87 years, with the average being 70.97 years.

The PSA levels [Table 1]. Preoperative serum PSA level was 9.82 ± 9.60 ng/mL. Compared with preoperative PSA value, the decrease of PSA value 5 days postsurgery was about 4.42 ± 8.78 ng/mL.
Table 1: The prostate-specific antigen levels

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A 35% decrease was recorded 1 month postsurgery. The data show a significant difference (P < 0.01) of PSA level between the five periods. The value of PSA >4 ng/mL group is still higher than that of PSA ≤4 ng/mL group after the decrease [Figure 1].
Figure 1: Effects of transurethral prostatic resection surgery on the change of prostate-specific antigen (bar chart): Prostate-specific antigen trended down after surgery and remained stable 1 month and up to 6 months of this evaluation

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There appears to be a linear relationship between the different resection extent of TURP surgery and the declination of PSA. With an increasing resection extent, PSA level decreases faster [Figure 2]. The mean differences between the real removal quantity and the quantity should be removed, with ± standard deviations.
Figure 2: Different resection sizes appear to have a linear relationship on the declination of prostate-specific antigen (scatter diagram)

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The value of the total sample is −0.941 ± 9.56 ng/mL, with 0.13 ± 10.53 for group PSA ≤4 ng/mL and −3.83 ± 5.41 for group PSA >4 ng/mL. There appears to be a positive correlation between the variations of PSA and the resection extent (P < 0.01, R = 0.91).

In addition, there also appears to be a positive correlation between the variations of PSA and the resection extent in the group of PSA ≤4 ng/mL and PSA >4 ng/mL (P < 0.01, R 1 = 0.986, R 2 = 0.924) [Table 2].
Table 2: A correlation analysis on different resection sizes and the declination of prostate-specific antigen

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  Discussion Top


Prostate cancer (PCa) can cause the increase of serum PSA. Other diseases such as BPH, symptomatic prostatitis, and operations of the prostate, as rectal touch or prostatic massage, can cause the increase of serum PSA.[4] Recently, the relationship between the increase of PSA level of BPH patients and prostate volume has been accepted by many scholars.[5]

For example, Roehrborn et al. have found that serum PSA is closely related to prostate volume.[6] Inflammation in the prostate gland can also lead to the increase of serum PSA.[7] Anim and et al. also put forward the “Seepage Theory” of prostate PSA.[8] Bosch et al. had used the method of Stepwise regression to correct prostate volume factors and drew a conclusion that PSA had no correlation with age.[9] This study also confirmed that prostate volume was closely related to preoperative PSA (P < 0.01); however, there is no statistical significance according to the comparison between the patient's age and preoperative PSA (P = 0.534).

TURP is the earliest application of prostatic endoscopic surgery. Now, it is regarded as a preferred method for the treatment of prostatic hyperplasia.[10] Usually, surgeons would remove the hyperplasia of transitional zone and periurethral portion of the gland and retain the surgical capsule-peripheral zone.

TURP can be a complex surgery; surgeons have different technical levels and proficiencies. Therefore, the resection extent of the hyperplasia of transitional zone in the surgery as well as the surgical time can vary. If resection is not thorough, hyperplasia will appear again, which will lead to the increase in serum PSA.[11]

Currently, it is reported that BPH patient's serum PSA had changed dramatically after TURP. However, limited research articles' reviews can be found on the influence of resection extent on BPH patients' serum PSA after TURP and whether PSA can be normally expressed on such resectional part compared with hyperplasia prostatic epithelium.[12] The change of patients' serum PSA was relatively flat after TURP surgery and reduced to normal levels in about 1 month.[13],[14]

Our results showed that BPH patients' serum PSA had changed dramatically 5 days, 1 month, and 3 months after TURP. Moreover, the serum PSA had dropped to 35% of preoperative level and tended to a stable level. The value of PSA >4 ng/mL group is still higher than that of PSA ≤4 ng/mL group after the postoperative decrease. Therefore, postoperative autologous PSA baseline should be regarded as a reference in postoperative monitoring of PSA. PSA = 4 ng/mL cannot be taken as the basic point to measure indications of prostate needle biopsies and the diagnosis of prostatic cancer. The BPH patients had a slight recovery half a year after TURP surgery, their PSA still remains at 4 ng/mL. This consequence may be related to the insufficient size of this study.

The results also show that in the case of same resection rate and ruling out the effect of the volume, the more adequate the resection is, the greater the declination of the PSA, and the earlier it is, the tendency is to remain at a stable level.


  Conclusion Top


In regards to patients whose preoperative PSA >4ng/mL, monitoring standards should be taken according to their postoperative PSA baseline, when measuring their results of prostate needle biopsies and the diagnosis of prostatic cancer.

There is no follow-up to PCa after resection of the situation; the number of cases should be expanded further and follow-up period should be extended for providing data for further scientific decision-making basis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nadji M, Tabei SZ, Castro A, Chu TM, Murphy GP, Wang MC, et al. Prostatic-specific antigen: An immunohistologic marker for prostatic neoplasms. Cancer 1981;48:1229-32.  Back to cited text no. 1
    
2.
van Renterghem K, Van Koeveringe G, Achten R, Van Kerrebroeck P. Clinical relevance of transurethral resection of the prostate in “asymptomatic” patients with an elevated prostate-specific antigen level. Eur Urol 2007;52:819-26.  Back to cited text no. 2
    
3.
Jieping W, Futai L, Zhong L, Wu JP. Wu Jieping's Urology. Jinan: Shandong Science & Technology Press; Vol. 2. 2013;1147.  Back to cited text no. 3
    
4.
Schatteman PH, Hoekx L, Wyndaele JJ, Jeuris W, Van Marck E. Inflammation in prostate biopsies of men without prostatic malignancy or clinical prostatitis: Correlation with total serum PSA and PSA density. Eur Urol 2000;37:404-12.  Back to cited text no. 4
    
5.
Okada K, Kojima M, Naya Y, Kamoi K, Yokoyama K, Takamatsu T, et al. Correlation of histological inflammation in needle biopsy specimens with serum prostate- specific antigen levels in men with negative biopsy for prostate cancer. Urology 2000;55:892-8.  Back to cited text no. 5
    
6.
Roehrborn CG, Boyle P, Gould AL, Waldstreicher J. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology 1999;53:581-9.  Back to cited text no. 6
    
7.
Liotta RF, Tarantino ML, Melloni D. Chronic prostatitis and PSA values. Urologia 2008;75:102-4.  Back to cited text no. 7
    
8.
Anim JT, Udo C, John B. Characterisation of inflammatory cells in benign prostatic hyperplasia. Acta Histochem 1998;100:439-49.  Back to cited text no. 8
    
9.
Bosch JL, Hop WC, Bangma CH, Kirkels WJ, Schröder FH. Prostate specific antigen in a community-based sample of men without prostate cancer: Correlations with prostate volume, age, body mass index, and symptoms of prostatism. Prostate 1995;27:241-9.  Back to cited text no. 9
    
10.
Doi H, Ichikawa S, Hiraoka A, Ichiryu M, Nakahara H, Ochi H, et al. Primitive neuroectodermal tumor of the pancreas. Intern Med 2009;48:329-33.  Back to cited text no. 10
    
11.
Partin AW, Oesterling JE. The clinical usefulness of prostate specific antigen: Update 1994. J Urol 1994;152:1358-68.  Back to cited text no. 11
    
12.
Yang TY, Chow YC, Lin WR, Ko MC, Chen M, Chang HK, et al. Concomitant transrectal ultrasound-guided biopsy and transurethral resection of prostate in patients with urinary retention and elevated serum prostate-specific antigen levels. J Chin Med Assoc 2016;79:605-8.  Back to cited text no. 12
    
13.
Fonseca RC, Gomes CM, Meireles EB, Freire GC, Srougi M. Prostate specific antigen levels following transurethral resection of the prostate. Int Braz J Urol 2008;34:41-8.  Back to cited text no. 13
    
14.
Hosseini SY, Salimi M, Hosseini Moghaddam SM. Changes in serum prostate-specific antigen level after prostatectomy in patients with benign prostatic hyperplasia. Urol J 2005;2:183-8.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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