Mahmoud MUSTAFA, Bedeir ALI-EL-DEIN, Tarek MOHSEN, El-Houssiny I. IBRAHIEM

Prostat taşları serum prostat spesifik antijen seviyesini artırır mı?

Bu çalışmada prostat taşlarının serum PSA düzeyini artırıp attırmadığı araştırılmıştır. Temmuz 2004 ile Mart 2005 tarihleri arasında transrektal ultrasonografi (TRUS) klavuzluğunda prostat biyopsisi yapılan ve benign prostat hiperplazisi (BPH) tanısı alan 110 hasta çalışmaya alınmıştır. Tüm hastaların serum PSA düzeyleri, parmakla rektal muayene (PRM) bulguları ve TRUS ile yapılan değerlendirmeden elde edilen prostat volümü ve prostat taşlan açısından değerlendirilmeleri kaydedildi. Hastalar PSA düzeyileri 20 ng/ml'nin üzerinde olanlar, 10-20 ng/ml arasında olanlar ve 10 ng/ml'nin altında olanlar şeklinde üç gruba ayrılarak değerlendirildiler. Yüz on hastanın 61'inde (%55.4) prostat taşı saptandı. Prostat taşı bulunması ile serum PSA düzeyleri arasında anlamlı bir ilişki gözlenmedi (p=0.3). Serum TPSA düzeyleri ile total ve transizyonel prostat hacmi arasında korelasyon gözlenmedi (r=0.05, r=0.02). 70 hastada (%63.6) TRUS'de heterojen eko özellikleri mevcuttu ve TRUS bulguları ile prostat taşı görülmesi arasında pozitif korelasyon saptandı (p=0.02). Prostat taşlarının serum PSA düzeylerini ve prostat hacmini etkilemediği gösterilmiştir. Total PSA düzeyleri ile,prostatın total ve transizyonel bölge hacmi arasında da korelasyon gözlenmemiştir.

Anahtar Kelimeler:

Prostat, Biyopsi, Prostata özgü antijen, Taş, Prostatit

Do the prostatic calculi cause high level of prostate-specific antigen?

We investigated whether the prostatic calculi might influence serum PSA level. Between July 2004 and March 2005, 110 patients who underwent sextant core transrectal ultrasound (TRUS) guided prostate biopsy and diagnosed as benign prostatic hyperplasia (BPH) were included. PSA serum level determination, digital rectal examination, prostate volume measurements and prostatic calculi detection by TRUS were done for all patients. The patients were divided according to their PSA values into three groups, PSA > 20 ng/ml, PSA 10-20 ng/ml and PSA < 10 ng /ml, respectively and evaluated separately. Prostatic calculi were detected in 61 of 110 patients (55.4%). There was no significant association between the presence of prostate calculi and PSA serum level (p = 0.3). There was no correlation between TPSA serum values and total or transition volume of prostate (r = 0. 05, r = 0.02). The heterogeneous echo-pattern findings at TRUS were found in 70 patients (63.6%) and there was positive correlation between the findings of TRUS and the presence of the prostatic calculi (p = 0.02). The presence of prostatic calculi does not influence the serum PSA level nor the prostate volume. There was no correlation between total PSA and total and transition zone volume of the prostate.

Keywords:

Prostate, Biopsy, Prostate-Specific Antigen, Calculi, Prostatitis,

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1.Stamey TA, Yang N, Hay AR et al: Prostate-specific antigen as serum marker for adenocarcinoma of the prostate. N Eng J Med, 317: 909, 1987.
2.Sutor, DJ. and Wooley, S : The crystalline composition of prostatic calculi. Br J Urol, 46: 533, 1974.
3.Torres RC, Aguilar RJ, Zuluaga GA et al: A crystallographic study of prostate calculi. J Urol, 124: 840, 1980.
4.Terris MK, Stamey TA.: Determination of prostate volume by transrectal ultrasound. J Urol, 145: 984, 1991.
5.Moon TD, Clejan S, Neal DE, Jr.: Prostate specific antigen and prostatitis. II. PSA production and release kinetics in vitro. Prostate, 20: 113, 1992.
6.Hasui Y, Marutsuka K, Asada Y et al: Relation ship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia. Prostate, 25: 90, 1994.
7.Nadler RB, Humphery PA, Smith DS et al: Effect of inflammation and benign prostate hyperplasia on elevated serum prostate specific antigen levels. J Urol, 55: 2000, 1995.
8.Okada K, Kojima M, Naya Y et al: Correlation of histological examination in needle biopsy specimens with serum prostate specific antigen levels in men with negative biopsy for prostate cancer. Urology, 55: 892, 2000.
9.Potts JM.: Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate-specific antigen. J Urol, 164: 1550,2000.
10.Irani J,Levillian P, Goujen JM et al: Inflammation in benign prostatic hyperplasia: correlation with prostate specific antigen value. J Urol, 157: 1301, 1997.
11.Hoekx L, Jeuris W, Van Mark E et al: Elevated serum prostate specific antigen( PSA) related to a symptomatic prostatic inflammation. Ada Urol Belg, 66:1, 1998.
12.Schatteman PH, Hoeks L, Wyndaele JJ et al: Inflammation in prostate biopsies of men without prostate malignancy or clinical prostatitis: correlation with total serum PSA and PSA density. Eur Urol, 37: 404, 2000.
13.Zhang W, Sesterhenn I A, Connelly RR et al: Inflammatory infiltrate (prostatitis) in whole mounted radical prostatectomy specimens from black and white patients is not an etiology for racial differences in prostate specific antigen. J Urol, 163: 131,2000.
14.Morote J, Lopez M, Encabo G et al: Effect of inflammation and benign prostatic enlargement on total and percent free serum prostate specific antigen. Eur Urol, 37: 537, 2000.
15.Mose PL,Burnner A,Horninger W etal: Correlation between inflammatory cells (T and B lymphocytes, macrophages) in prostate biopsies and elevated PSA in a PSA screening population. Urology, 59: 68, 2002.
16.Nickel JC, Downey J, Young I et al: Asymptomatic inflammation and/or infection in benign prostatic hyperplasia.i£JI/M 84: 976 ,1999.
17.Sang EL, Ja HK, Hyoung KP et al: Prostatic calculi don't influence the level of serum prostate-sepecific antigen in men without clinically detectable prostate cancer or prostatitis.J Urol, 170: 745-748, 2003.
18.Sondergaard G, Venter M, Christensen PO.: Prostatic calculi. Acta Pathol Microbiol I mmunol Scand(A), 95: 141,1987.
19.Gumus BH, Neşe N, Gunduz MI et al: Does asymptomatic inflammation increase PSA?A histopathological study comparing benign and malignant tissue biopsy specimens.Int Urol Nephrol, 36(4):549-53, 2004,