Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 4
The correlation between PSA and nitric oxide value in BPH and prostatic cancer patients
- Pages
- 410–413
- DOI
- —
Abstract
Introduction: New methods for early diagnosis and treatment of prostate cancer are continuously being developed. The large majority of prostate cancers and also benign prostate hyperplasi (BPH) are detected, via prostate- specific antigen (PSA) screening. However, management policies for patients with PSA levels in the so called “gray zone”, i.e. between 2.5-10ng/ml are not clear. PSA density, PSA velocity, Free/Total PSA, complex PSA and age adjusted PSA levels have been suggested as adjuvant markers for treatment decisions for these patients. Nitric oxide (NO) was first introduced by Furcgatt and Zawadzki in 1980 as a vasodilatator which is secreted by endothelium. NO produced by the enzyme nitric oxide synthase during the transformation of L-arginin to L-sitrulin. NO has many functions in the body; smooth muscle relaxation, inhibition of aggregation of thrombocites, acting as a neurotransmitter in the brain, as well as having a role in inflammation and immunology. The inducible NOS (i-nos) isn’t calcium dependent-analysis particularly found in thrombocytes and the liver. Its release is stimulated by bacterial endotoxins and cytokines. In this prospective study our objective was to search for a probable correlation between various PSA levels and NO levels in BPH, prostate cancer and other urinary tract malignancies. Materials and Methods: Between August 2001 and February 2002, 90 male patients with LUTS and 15 healthy volunteers (age 70±15) were included in this study. These patients didn’t have acute infection. Those using nitrates were excluded. Urinary obstruction was diagnosed by uroflowmetry and 90 patients were introduced to the study prospectively. Patients were categorized in 7 groups as follows; control, BPH (2 groups; first PSA 2.5-10 and second 10 ng/ml and higher), P Ca (3 groups; first, PSA 2.5-10, second 10 ng/ml and higher, and thirdly; patients who underwent radical prostatectomy), and other urinary tract malignancies. Each group consisted of 15 cases and each case had histopathologic correlation. All the serum samples were frozen et -70°C before they were used. Serum total PSA levels were identified using electrochemiluminesance (ECL) method with roche 2010 system. Serum NO levels were measured using the reduction of nitrate to nitrite which can be measured after a colorimetric reaction with Griess reagent. Results: NO value for the control group was 4.55±1.57 uM. PSA values for the first BPH group was 6.44±2.84 uM and for the second BPH group it was 6.47±2.41 uM. PSA values for 3 P Ca groups were 8.88±5,34 ulvl, 7.74±3.49 uM, 5.56±1.81 uM respectively. NO levels were statistically significantly high in BPH, P Ca and other urinary tract malignancies (p<0.01). NO increased in the BPH group did not correlate with PSA. NO increase was higher in P Ca and other urinary tract malignancies when compared to BPH. NO increase in P Ca cases with PSA levels 2.5-10 ng/ml was statistically significantly higher than those with PSA levels 10 ng/ml and higher. There was a statistically significant decrease in NO levels in patients who underwent radical cystoprostatectomy by the post operative third month (PSA: 0.01±0.01 ng/ml). There was no statistically significant difference with in the control group. Conclusion: Our results show that NO levels increase both in BPH and other urinary tract malignancies; the increase is higher in malignancies. Significant decrease in NO levels in patients that had undergone radical prostatectomy suggests that there might be a correlation between NO levels and carcinoma.
Özet
Nitrik oksit (NO) organizmada nitrik oksit sentaz katalizörlüğünde L-Arginin.L-Sitrulin dönüşümü esnasında oluşturulur ve genitoüriner sistemin sekretuar fonksiyonunda, düz kas tonus regülasyonunda yer alan bir mediatördür. PSA prostat hücre stoplazmasında salgılanan 33kD molekül ağırlığında bir glikoproteindir. Serin proteazdır. Çalışmamızda, BPH, Prostatik karsinoma ve diğer üriner sistem tümörlü hastaların farklı PSA değerlerine göre serum NO değerlerini karşılaştırdık. Ağustos 2001-Şubat 2002 tarihleri arasında hastanemize AUSS ile başvuran 90 erkek hasta ve 15 sağlıklı erkek gönüllü (yaş 70±15)çalışmaya dahil edilmiştir. Hastalar, kontrol, BPH (PSA: 2,5-10 ve 10 ng/ml üstü olmak üzere 2 grup), PCa (2,5-10, 10 ng/ml üstü ve radikal prostatektomili grup olmak üzere 3 grup) ve diğer üriner sistem tümörleri olarak 7 ayrı grupta toplanmaktadır. Her grupta olgu sayısı 15’tir.Tüm olguların tanıları patolojik olarak doğrulanmıştır. Serum PSA değeri ECL yöntemi ile ölçülürken serum NO değerleri nitrat-nitrit indirgeme metodu ile Griess ayıracı kullanılarak spektrofotometrik olarak ölçülmüştür. NO değerleri kontrol grubu için 4,55±1,57uM; BPH 1.grup (PSA: 2,5-10) 6,44±2,84uM; BPH 2.grup (PSA 10'dan büyük) 6,47±2,41ulvl; PCa1.grup (PSA: 2,5-10) 8,88±5,34 uM; PCa 2.grup (PSA 10'dan büyük) 7,74±3,49 uM; PCa 3.grup (Radikal prostatektomili grup) 5,56v1.81 uM; diğer üriner sistem tümörlü grupta 7,84±1,74 uM olarak ölçüldü. NO seviyesi BPH, Pca ve diğer üriner system tümörlerinde anlamlı olarak yüksek bulunmuştur (p<0,01). BPH grubundaki NO artışı PSA değerlerindeki artış ile korelasyon göstermemektedir. PCa ve diğer üriner sistem tümörlerindeki NO artışı BPH grubundakinden fazladır (p<0,05). Prostat kanseri olup da PSA seviyesi 2,5-10 ng/ml olan gruptaki NO artışı, PSA seviyesi 10 üzerindeki grubun NO seviyesi artışından daha fazladır (p<0,05). Radikal prostatektomili (Ameliyat sonrası 3.ay PSA: 0,01±0,01ng/ml) hastaların ameliyat sonrası 6.ayda yapılan NO ölçümlerinde anlamlı bir azalma saptanmıştır (p<0.01). Kontrol grubu ile istatistiksel bir fark saptanamamıştır. Serum NO seviyelerinde BPH ve üriner sistem malinitesi olan hastalarda artış gözlenmekle birlikte malinensilerde bu artış daha yüksek gözlenmiştir. Radikal prostatektomi yapılan gruptaki NO seviyesinin belirgin olarak düşmesi karsinoma ile serum NO düzeyi arasında bir korelasyon olabileceğini düşündürmektedir. Kesin bir sonuca varmak için daha geniş kapsamlı çalışmaların gerekli olduğu kanısındayız.