Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 2
Selim prostat hiperplazili hastalarda transüretral prostat rezeksiyonunun serum prostat spesifik antijen düzeyine etkileri
- Sayfa
- 215–219
- DOI
- —
Özet
Bu çalışmada selim prostat hiperplazisi (BPH) tanısı alan hastalarda transüretral prostat rezeksiyonunun (TURP) serum prostat spesifik antijeni (PSA) düzeyi üzerine olan erken dönem etkilerini değerlendirdik.Gaziosmanpaşa Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı Kliniği’nde Nisan-Aralık 2003 tarihleri arasında TURP yapılan ve çıkarılan dokuların patolojik incelemesinde BPH tanısı konulan 22 hastanın ameliyat öncesi ve sonrası dönemde serum PSA düzeyleri ölçüldü. Sonuç olarak ameliyat öncesi ortalama 5.70 ng/mL olan PSA değerlerinde ameliyat sonrası 8., 24. ve 72. saatlerde anlamlı artış görülürken (p<0.05), ameliyat sonrası 30. gün serum PSA ortalaması ameliyat öncesi ortalamaya göre anlamlı olarak daha düşük bulundu (p<0.05). Operasyon sonrası hastaların ortalama prostat hacimlerinde %53’lük bir azalma olurken, ameliyat sonrası birinci ay sonunda rezeke edilen gram doku başına ortalama serum PSA düzeylerinde 0.11ng/mL/gr azalma saptandı (r = 0.503, p<0.05). Sonuç olarak, TURP operasyonu yapılan ve histopatolojik olarak BPH tanısı alan hastalarda erken ameliyat sonrası dönemde önemli oranda artan serum PSA seviyesi birinci ay sonunda ameliyat öncesi düzeyin de altına düşmektedir, buna göre prostatektomi geçiren hastalarda ameliyat sonrası serum PSA düzeyleri yorumlanırken dikkatli olunmalı ve bu hasta popülasyonunda yeni ve normalden daha düşük bir referans aralığının oluşabileceği akılda tutulmalıdır.
Abstract
Introduction: Prostate specific antigen (PSA) is the most clinically useful tumor marker in the early diagnosis and monitoring of prostate cancer (PCa). It is a kallikrein like serine protease produced and secreted by the epithelial cells of the prostate. PSA is not only specific for PCa but also serum levels of it can be increased in some benign conditions, such as benign prostatic hyperplasia (BPH) or prostatitis and after some interventions such as cystoscopy, prostate biopsy, digital rectal examination of prostate and transurethral resection of prostate (TURP). There are some clinical studies investigating the early and late effects of TURP and other manipulations on serum levels of PSA in the literature. In this study, we aimed to show the effects of TURP on serum PSA levels of men with BPH in early postoperative period (first seventy-two hours), and have proceeded to follow the serum PSA levels of the same patients, whether the effects of TURP on PSA levels were maintained at the end of the first postoperative month. The correlation between the weight of resected prostatic tissue and new reference range of PSA after partial prostatectomy was also investigated. Materials and Methods: A prospective study was carried out in Urology Clinics of Gaziosmanpasa University Hospital between April 2003 and December 2003. Twenty-two consecutive patients who underwent TURP operation due to lower urinary tract symptoms were enrolled to the study. Histopathologically, diagnosis of BPH was confirmed for all patients. Routine biochemical and hematologic tests, dipstick test and culture of urine, uroflowmetry and transrectal ultrasound examination to calculate prostate volume were performed for all patients preoperatively. Serum PSA levels were measured before the operation and within postoperative 8th, 24th and 72nd hours and at the end of the first postoperative month afterwards. The change in serum PSA (preoperative- early and late postoperative) was calculated for each patient and for all the group and the results were compared statistically with paired simple t-test. The correlation between the mean PSA change value and the weight of resected prostatic tissue was evaluated with Pearson Correlation Test. Results: For all the group there was a sharp and statistically significant PSA rise immediately following TURP. The mean preoperative value of PSA (5.70 ng/mL) increased in postoperative 8th, 24th, and 72nd hours to 20.63 ng/mL, 15.50 ng/mL and 10.18 ng/mL respectively. All these values were significantly higher than preoperative means (p<0.05), and these values decreased to 2.44 ng/mL at the end of the first postoperative month. When compared to preoperative means this was a significant decrease (p<0.05). On the average prostate volume were reduced 53% in patients and removal of 1 gr. of BPH tissue resulted a statistically significant reduction in serum PSA approximately 0.11 ng/mL/gr (r= 0.503, p<0.05). Conclusion: We found out that, TURP causes significant increase in the serum PSA level in early postoperative period which usually returns to a stable, baseline level within one month. The PSA reference range for the specific population of men who underwent prior partial prostatectomy appears to be lower than that for normal population and it is recommended to be cautious when interpreting PSA levels in such patients. This demonstration that TURP significantly increases the PSA level in early postoperative period supports the idea of avoiding such measurements immediately after TURP and such measurements to increase the detection rate of PCa should be done after a time interval of approximately one month postoperatively.