ABSTRACT
OBJECTIVE: The measurement of prostate-specific antigen (PSA) is a useful tool in the screening and follow-up of prostate cancer, but its diagnostic validity is uncertain in hemodialysis patients. The aim of this study was to evaluate the effects of hemodialysis on serum complexed PSA (cPSA) levels. MATERIAL AND METHODS: A total of 36 men (mean age 62.54+/-8.20 years) with end-stage renal disease were enrolled in a prospective study. Serum total PSA (tPSA), free PSA (fPSA) and cPSA, and hematocrit levels were measured before and immediately after dialysis using low-flux membranes in the serum and in the dialysis ultrafiltrate. RESULTS: After hemodialysis, cPSA, fPSA and the fPSA:tPSA ratio increased significantly (p<0.05). However, there was no significant increase in tPSA. fPSA, cPSA and tPSA were not detected in ultrafiltrate. Hematocrit levels increased significantly (p<0.0001) due to hemoconcentration. Of patients with initial serum tPSA and cPSA values and fPSA:tPSA ratios below the cut-off values, none had a post-hemodialysis value greater than the cut-off point. There were weak correlation between the difference in values after and before hemodialysis of hematocrit and cPSA (p=0.035), and between the percentage change in levels before and after hemodialysis of hematocrit and cPSA (p=0.041). CONCLUSIONS: Hemodialysis induced elevations in all forms of PSA, but tPSA was the least affected form. cPSA did not show any diagnostic superiority over other forms of PSA. Thus, serum tPSA remains a reliable parameter for follow-up of prostate cancer in uremic patients receiving long-term dialysis. However, further research is needed to explain the pathophysiology of alterations in the concentrations of different forms of PSA.
Subject(s)
Prostate-Specific Antigen/blood , Renal Dialysis , Aged , Humans , Male , Middle AgedABSTRACT
OBJECTIVES: To evaluate the effects of prostatic massage on the serum complexed PSA (cPSA) concentration in various prostatic diseases. METHODS: A total of 51 men who presented to our outpatient clinic for the first time with symptoms of lower urinary outflow obstruction were included in this study. Blood samples were obtained from each patient before and 30 minutes after prostatic massage. Total PSA (tPSA), free PSA (fPSA), and cPSA levels were measured using a chemiluminescent enzyme immunoassay. RESULTS: After prostatic massage, the tPSA and fPSA levels and fPSA/tPSA ratio increased significantly (P < 0.0001), and the increase in cPSA was minimal but statistically significant (P = 0.047). In patients with prostate cancer, no significant increase occurred in the mean forms of PSA (tPSA, cPSA, and fPSA/tPSA ratio), except for fPSA, after prostatic massage. We observed a greater increase in all PSA forms in the chronic prostatitis group. CONCLUSIONS: In this study, prostatic massage increased serum cPSA concentration, but to a lesser extent than tPSA and fPSA.
