Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 2
BPH ön tanısıyla açık prostatektomi uygulanan hastalarda ameliyat sonrası serbest ve total PSA seviyeleri
- Sayfa
- 235–238
- DOI
- —
Özet
Bu çalışmamızda, açık prostatektomi sonrası serbest ve total PSA değişikliklerinin belirlenmesi ve daha sonraki prostat kanser taramaları için bazal bir PSA değerinin saptanmasını amaçladık. Son 3 yıl içinde transvesikal prostatektomi yapılan, patoloji sonucu BPH gelen ve aşağıdaki kriterlere uyan 30 hasta prospektif olarak çalışmaya dahil edildi. PSA tüm olgularda monoklonal Tandem R yöntemi ile bakıldı. Açık prostatektomi sonrası PSA ölçümü 3’üncü ay yada daha sonra yapıldı. İstatistiksel analizde χ2 -test kullanıldı. Opere edilen hastaların yaş ortalaması 67, operasyonda çıkarılan ortalama adenom prostat ağırlığı 81.5 gr., ameliyat öncesi total PSA ortalaması 11.8 (0.47-54.5) ng/ml, serbest PSA ortalaması 1.4 (9.5-0.33) ng/ml ve ortalama serbest/total PSA 0.20 olarak bulunurken, ameliyat sonrası total PSA ortalaması 1.3 (0.11-3.36) ng/ml, serbest PSA ortalaması 0.18 (0.05-0.92) ng/ml, ortalama serbest/total PSA 0.14 olarak bulundu. Ameliyat sonrası total PSA’da ortalama %89 azalma ve ortalama serbest PSA’da %87 azalma tespit edildi (p<0.05). Açık prostatektomi sonrası olgularda bazal ortalama PSA seviyesi 1,3±0,99 ng/ml seviyesine inmektedir. Bu değer hastaların prostat kanser takibinde referans oran olarak alınabilir.
Abstract
Introduction: The cut-off value of PSA level for screening after radical prostatectomy is 0.2 ng/ml after radical prostatectomy. But there isn’t any data about the screening value of PSA after surgery for benign disease. The aim of this study is to evaluate the changes of free and total PSA level after open prostatectomy and to determine a baseline PSA level for prostate cancer screening whom underwent open prostatectomy for benign disease. Materials and Methods: During last 3 years, 30 patients who were treated with transvesical prostatectomy for BPH were included in this study prospectively. PSA levels have been measured with monoclonal Tandem R method within 3 months or more after open prostatectomy in all cases. Total and free PSA levels of patients with acute urinary retention are measured 3 weeks after the sistostomy procedure. Patients who were taking finasteride, who were treated for acute bacterial prostatitis and who underwent a transrectal ultrasound (TRUS) guided biopsy were excluded. Prostatectomy was performed transvesically. All total and free PSA levels were measured 3 months after prostatectomy. χ2-test was used for statistical analyses. Results: The median age of patients operated was 67 (49- 88) years and the average weight of prostatic tissue removed during operations was 81.5 g. While the average preoperative total PSA level was 11.8 (0.47-54.5) ng/ml, the average preoperative free PSA level was 1.4 (9.5-0.33) ng/ml, the average preoperative free/total PSA level was 0.20; the average postoperative total PSA level is 1.3 (0.11-3.36) ng/ml, the average postoperative free PSA level is 0.18 (0.05-0.92) ng/ml, the average postoperative free/total PSA level is 0.14 ng/ml. The average total PSA level was decreased 10.5 ng/ml (89%); the average postoperative free PSA level decreased 2.28 ng/ml (87%). There was a statistically significant difference between preoperative and postoperative total PSA (p<0.05) and between the removed adenoma tissue and the difference in PSA level (p<0.05). There wasn’t any association between age related PSA levels and postoperative PSA levels (p>0.05). The decrease of total PSA level per 1 gram of adenoma is 0.128 ng/ml and the decrease of free PSA level per 1 gram of adenoma is 0.027 ng/ml. Conclusion: There is a decrease of baseline average total PSA levels to 1.3±0.99 ng/ml and baseline average free PSA levels to 0.18±0.16 ng/ml after open prostatectomy. Open prostatectomy is performed widely as much as transurethral resection of prostate in Turkey. Because the PSA levels depend heavily on the transitional zone of the prostate, total and free PSA levels decrease after prostatectomy. Data about the PSA levels after transurethral resection of prostate can be found in the literature but there isn’t any reference PSA value for patients who underwent open prostatectomy and suspected to have a prostate cancer. This PSA level might be taken as a reference range for patients who underwent open prostatectomy if they are suspected to have prostate cancer.