Ahmet HACIİSLAMOĞLU, İsmail EVREN, Abdullah Hızır YAVUZSAN, İsmail YİĞİTBAŞI, Mithat EKŞİ, Kamil Gökhan ŞEKER, Volkan TUĞCU

Prostat Spesifik Antijenin Akut Üriner Retansiyon Sonrası Üretral Kateter Yerleştirilen ve Benign Prostat Hiperplazisi Olan Hastalarda Prostat Adenokarsinomu Saptamadaki Rolü

Amaç: Akut idrar retansiyonu (AİR) benign prostat hiperplazisi (BPH) hastalarında en önemli komplikasyonlardan biridir ve tedavisi genellikle akut dönemde üretral kateterizasyondur. AİR ve üretral kateter yerleştirilmesinin serum PSA seviyelerinde bir artışa neden olabileceğini gösteren çalışmalar vardır. Bu çalışmada amacımız, AİR sonrası üretral kateter yerleştirilen hasta grubunda artmış PSA düzeyleri ile prostat kanseri (PCa) insidansı arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: AUR nedeniyle kalıcı bir üretral kateteri olan 77 hastada, yüksek PSA seviyeleri nedeniyle yapılan prostat biyopsileri ve daha sonra klinik BPH için yapılan cerrahi tedaviler retrospektif olarak incelendi. Hastaların yaş, prostat hacimleri, biyopsi öncesi total serum PSA ve PSA dansiteleri kaydedildi. Biyopsi veya cerrahi örnek sonuçlarına göre total PSA oranları, PSA dansiteleri ve prostat hacimleri PCa’nın saptandığı (n = 6) ve saptanmadığı (n = 71) gruplar için karşılaştırıldı.Bulgular: Hastaların yaş ortalaması 65.2 ± 3.9 idi. Ortalama prostat hacmi 64.1 ± 12.8 g, ortalama serum total PSA seviyesi 9.2 ± 4.2 ng / mL ve ortalama serum PSA dansitesi 0.15 ± 0.08 mg / mL / g olarak ölçülmüştür. Serum total PSA düzeyi ≤4.0, 4-10, 10-20 ve >20 olan PSA gruplarında PCa prevalansı sırasıyla % 0, % 4,3, % 13,4 ve % 20 olarak tespit edildi. Toplam PSA düzeyleri ve PSA dansiteleri, PCa tespit edilen grupta istatistiksel olarak daha yüksek bulundu.Sonuç: AİR sonrası üretral kateter yerleştirilen hastalarda PCa insidansı düşüktür. Bu hastalar için prostat biyopsisi sadece seçilmiş vakalarda yapılmalıdır.

Anahtar Kelimeler:

acute urinary retention, biopsy, prostate cancer

Role of Prostate Specific Antijen in Prostatic Adenocarcinoma Detection in Patients with Benign Prostate Hyperplasia and Were Placed Urethral Catheter After Acute Urinary Retention

Objective: Acute urinary retension (AUR) is one of the most important complications in benign prostate hyperplasia (BPH) patients and its treatment is generally urethral catheterization in acute period. There are studies showing that AUR and urethral catheter placement may cause an increase in serum PSA levels. Our objective in this study was to investigate the relation between increased PSA levels and prostate cancer (PCa) incidence in the patient group after AUR and urethral catheter placement.Materials and Methods: 77 patients who had an indwelling urethral catheter due to AUR, performed prostate biopsy due to high PSA levels and then surgical treatment for clinic BPH were retrospectively examined. Age, prostate volumes, pre-biopsy total serum PSA and PSA densities were noted. Total serum PSA rates, PSA densities and prostate volumes were compared for the groups that PCa was detected (n=6) and not detected (n=71) according to biopsy or surgical specimen results.Results: Mean age of the patients was 65.2±3.9 years. Mean prostate volume was measured as 64.1±12.8 g, mean serum total PSA level as 9.2±4.2 ng/mL and mean serum PSA density as 0.15±0.08 mg/mL/g. In PSA groups with a serum total PSA level of ≤4.0, 4-10, 10-20 and >20, PCa prevalence rates were detected 0%, 4.3%, 13.4% and 20%, respectively. Total PSA levels and PSA densities were found statistically higher in PCa detected group.Conclusion: PCa incidence is low in patients who were placed urethral catheter after AUR. For these patients prostate biopsy should be performed only in chosen cases.

Keywords:

acute urinary retention, biopsy, prostate cancer,

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References
1. Bushman W. Etiology, epidemiology, and natural history of benign prostatic hyperplasia. Urol Clin North Am 2009;36:403–15. 2. Bosch JL, Hop WC, Kirkels WJ, Schröder FH. The international prostate symptom score in a community-based sample of men between 55 and 74 years of age: prevalence and correlation of symptoms with age, prostate volume, flow rate, and residual urine volume. Br J Urol. 1995;75(5):622–630. 3. Orsted DD, Bojesen SE, Nielsen SF, Nordestgaard BG. Association of clinical benign prostate hyperplasia with prostate cancer incidence and mortality revisited: a nationwide cohort study of 3,009,258 men. Eur Urol. 2011 Oct;60(4):691-8.4. Alcaraz A, Hammerer P, Tubaro A, Schröder FH, Castro R. Is there evidence of a relationship between benign prostatic hyperplasia and prostate cancer? Findings of a literature review. Eur Urol 2009; 55(4):864–873
5. Schenk JM, Kristal AR, Arnold KB, et al. Association of symptomatic benign prostatic hyperplasia and prostate cancer: results from the prostate cancer prevention trial. Am J Epidemiol 2011, 173(12):1419–1428
6. Simons BD, Morrison AS, Young RH, Verhoek-Oftedahl W. The relation of surgery for prostatic hypertrophy to carcinoma of the prostate. Am J Epidemiol 1999; 138(5):294–300 7. Kefi A, Koseoglu H, Celebi I, Yorukoglu K, Esen A. Relation between acute urinary retention, chronic prostatic inflammation, and accompanying elevated prostate-specific antigen. Scand J Urol Nephrol 2006;40:155–60.
8. Shadi Al-Khalil, Christine Ibilibor, James Thomas Cammack, Werner de Riese. Association of prostate volume with incidence and aggressiveness of prostate cancer. Res Rep Urol. 2016; 8: 201-205.9. Kravchick S, Bunkin I, Peled R, et al. Patients with elevated serum PSA and indwelling catheter after acute urinary retention: prospective study of 63 patients with 7-year follow-up. J Endourol. 2007 Oct;21(10):1203-6.
10. Antunes AA, Barbosa JA, Reis ST, et al. Prostate biopsy in patients with long-term use of indwelling bladder catheter: What is the rationale? Urol Oncol. 2012 Sep;30(5):620-3.11. Lilja H, Ulmert D, Vickers AJ. Prostate-specific antigen and prostatecancer: Prediction, detection, and monitoring. Nat Rev Cancer 2008;8:268–78.12. Pienta KJ. Critical appraisal of prostate-specific antigen in prostatecancer screening: 20 years later. Urology 2009;73:S11–S20.13. Parekh N, Lin Y, Marcella S, Kant AK, Lu-Yao G. Associations of lifestyle andphysiologic factors with prostate-specific antigen concentrations: Evidence from the National Health and Nutrition Examination Survey(2001–2004). Cancer Epidemiol Biomarkers Prev 2008;17:2467–72.14. McNeill SA, Hargreave TB. Efficacy of PSA in the detection ofcarcinoma of the prostate in patients presenting with acute urinaryretention. R Coll Surg Edinb 45(4):227–30, 2000.15. Feero P, Nickel JC, Brawn P, Young I. Prostatic infarction associated with aortic and iliac aneurism repair. J Urol 143:367–8, 1990.16. Batislam E, Arik AI, Karakoc A, Uygur MC, Germiyanoglu RC, Erol D. Effect of transurethral indwelling catheter serum prostate- specific antigen level in benign prostatic hyperplasia. Urology 49(1):50–4, 1997.17. Catalona WJ, Smith DS, Ratliff TL, et al. Measurement of prostate specific antigen in serum as a screening test for prostate cancer.N Engl J Med 1991;324:1156–61.18. Brawer MK, Chetner MP, Beatie J, Buchner DM, Vessella RL, Lange PH. Screening for prostatic carcinoma with prostate specific antigen. J Urol. 1992 Mar;147(3 Pt 2):841-5.19. Pinsky PF, Kramer BS, Crawford ED, et al. Prostate volume and prostate-specific antigen levels in men enrolled in a large screening trial. Urology. 2006 Aug;68(2):352-6.20. Mochtar CA, Kiemeney LA, van Riemsdijk MM, et al. Prostate-specific antigen as an estimator of prostate volume in the management of patients with symptomatic benign prostatic hyperplasia. Eur Urol. 2003 Dec;44(6):695-700.21. Putra IB, Hamid AR, Mochtar CA, Umbas R. Relationship of age, prostate-specific antigen,and prostate volume in Indonesian men with benign prostatic hyperplasia. Prostate Int. 2016 Jun;4(2):43-8.22. Agnihotri S, Mittal RD, Kapoor R, Mandhani A. Asymptomatic prostatic inflammation in men with clinical BPH and erectile dysfunction affects the positive predictive value of the prostate-specific antigen. Urol Oncol. 2014 Oct;32(7):946-51.23. Yli-Hemminki TH, Laurila M, Auvinen A, et al. Histological inflammation and risk of subsequent prostate cancer among men with initially elevated serum prostate-specific antigen (PSA) concentration in the Finnish prostate cancer screening trial. BJU Int. 2013 Oct;112(6):735-41.