Dergiler / Türk Üroloji Dergisi/Turkish Journal of Urology / 2004 / Cilt: 30 - Sayı: 3
Parmakla rektal incelemenin prostat kanserli olgularda serum PSA seviyeleri üzerine etkisi
- Sayfa
- 286–289
- DOI
- —
Özet
Bu çalışmada prostat kanserli olgularda parmakla rektal incelemenin (PRİ) prostat spesifik antijen (PSA) seviyeleri üzerindeki etkisini irdelemeyi amaçladık. Çalışmaya prospektif olarak 30 prostat kanserli hasta alındı. Kontrol grubu olarak da çalışma grubu ile yaş uyumlu 28 BPH’lı hasta seçildi. Hastalara standart PRİ tek kişi tarafından yapıldı. Hastalardan PRİ öncesi ve PRİ’den 30 dakika sonra tekrar PSA analizi için kan alındı. İstatistiksel değerlendirmede Wilcoxon testi ve Mann Whitney U testi kullanıldı. Çalışma grubundaki hastaların 25’inde (%84) serum PSA değerinde artış olduğu izlendi. PRİ sonrası bakılan serum PSA seviyelerinde önceki PSA seviyelerine oranla ortalama %73’lük bir artış saptandı (p=0.001). BPH gurubunda 15 hastada (%54) serum PSA seviyelerinde istatistiksel olarak anlamlı sayılmayacak artışlar görüldü (p>0.05). İstatistiksel analizde Wilcoxon (SSPS 10) testi ve Mann Whitney U testi kullanıldı. Prostat kanserli hastalarda PRİ sonrası serum PSA seviyelerinde izlenen artış dikkat çekicidir. Serum PSA değeri yüksek olan ancak transrektal ultrason ile biyopsi sonucu negatif gelen hastalarda PRİ sonrası serum PSA değerinde artış saptanması gizli prostat kanseri odağının ısrarlı araştırılmasında önemli bir araç olabileceğini düşünüyoruz.
Abstract
Introduction: In this study our goal is to evaluate, if digital rectal examination (DRE) of prostate causes statistically meaningful changes on serum prostate specific antigene (PSA) values in patients with prostate cancer. Materials and Methods: Thirty patients with prostate cancer were included in this clinical trial prospectively. We have chosen 28 patients with BPH as a control group in the same age range with the study group. Patients in the prostate cancer group were diagnosed by TRUS guided prostate biopsy. Patients having serum PSA value between 4 and 10 ng/dl, underwent TRUS guided prostate biopsy in the prostate cancer group. These patients included in this trial six months after the TRUS guided prostate biopsy. The patients having acute urinary tract infection, acute prostatitis, a report of any malign pathology and a history of chateterization or cystoscopy recently were excluded from the study. A standard DRE was performed to all patients in both groups by the same physician. Serum PSA values were analyzed before and after 30 minutes of DRE. Statistical assessment was made with Wilcoxon (SSPS 10) test and Mann Whitney U test. Results: In the prostate cancer group serum PSA values before DRE was obtained as 29.69±31.6 (2.3-127) ng/dl and 41.16±41.25 (5.2-169) ng/dl after DRE. In the study group, serum PSA levels were increased in 25 patients (84%). An increase meanly 73% was determined in serum PSA levels after DRE in comparison to serum PSA levels before DRE (p=0.001). Serum PSA values of the control group before DRE was obtained as 4.1±2.3 (0.5-9.1) and 4.41±2.5 (0.4-10.5) after DRE. In patients with BPH, 15 patients (54%) showed statistically non meaningful increases in serum PSA levels (p>0.05). A decrease meanly six percent of serum PSA values was observed in the control group patients with BPH, but this decrease was not statistically significant (p<0.05). Conclusion: In the prostate cancer group, we obtained a serum PSA increase after DRE which was meaningful statistically. Detection of increasing serum PSA levels after DRE, in patients who had high serum PSA levels and (-) TRUS guided prostate biopsy result, may be an important sign for insistently detection occult prostate cancer focus. Detection of increasing levels of serum PSA after DRE, may be a useful tool in the decision of re-biopsy in a group of patients who have high serum PSA levels with negative first biopsy result.