Serum Prostat-Spesifik Antijen Düzeyi 2,5-10 Ng/Ml Arasındaki Erkeklerde İki Kadeh Testinin Prostat Biyopsisi ve Asemptomatik Prostat İnflamasyonu Varlığı ve Derecesiyle İlişkisinin Araştırılması

Year 2024, Volume: 16 Issue: 1, 54 - 59, 14.03.2024

Alpaslan Yüksel , Ali Tekin , Yusuf Şenoğlu , Dursun Baba , Mehmet Gamsızkan

https://doi.org/10.18521/ktd.1367501

Abstract

Amaç: Prostat-spesifik antijen (PSA) prostat kanserini belirlemede kullanılan bir belirteçtir. Yüksek PSA değerleri saptandığında prostat kanseri olasılığı düşünülerek prostat biyopsisi uygulanmaktadır. PSA yüksekliği, prostat kanserine spesifik olmayıp benign prostat hiperplazisi (BPH) , idrar yolu enfeksiyonu ve kronik prostatit gibi durumlardan da kaynaklanabilmektedir. .Biyopsi yapılan hastaların yaklaşık %66’sında prostat kanseri saptanmayıp, hastalar gereksiz biyopsiye ve biyopsi komplikasyonlarına maruz kalmaktadır. Bu biyopsilerin yaklaşık % 40’ında kronik prostatit saptanmaktadır.İki kadeh testi kronik prostatit tanısında kullanılan rektal tuşe öncesi ve sonrası idrarın incelenmesine dayanır. Biz bu çalışmamızda PSA değeri 2,5-10 ng/ml arasında olan ve prostat iğne biyopsisi uygulanmış hastalarda prostatit insidansını ve infalamasyonu öngörmesi açısından iki kadeh testinin etkinliğini ortaya çıkarmayı amaçladık.

Materyal ve Yöntem: Kliniğimize başvuran yaşları 50 ile 78, PSA değerleri 2.5-10 ng/ml arasında olan 52 erkek hasta çalışmaya alındı. Tüm hastalara EPS –iki kadeh testi incelemesi ve prostat biyopsisi uygulandı. EPS; prostat masajı sonrası üretraya gelen sıvının alınması ile elde edilen örneği; VB-3; masajdan sonra işenen yaklaşık 10 ml’lik idrarın alınması İle Sağlanan İdrarı Gösterir. EPS Ve VB3 Prostat İnfeksiyonunu Saptar. Mikroskop Altında ≥10 lökosit prostat inflamasyonu için anlamlı kabül edildi. Hastalar çıkan patoloji sonucuna göre Prostat kanseri, BPH ve Kronik prostatit şeklinde 3 gruba ayrıldı. Kronik prostatitli grup Nickel’in tanımladığı histopatolojik kalsifikasyonuna göre sınıflandırıldı.

Bulgular: Bu çalışmada kronik prostatit prevelansı %38 olarak bulundu. VB3 pozitifliği diğer gruplara göre kronik prostatit grubunda istatistiksel olarak anlamlı bulundu ( p = 0,028). İnflamasyon yaygınlığı ile PSA yüksekliği arasında istatistiksel olarak anlamlılık saptanmasa da PSA multifokal inflamasyonlu alt grupta fokal inflamasyonlu hasta grubuna göre daha yüksek bulunmuştur.

Sonuç: Kronik prostatit ile PSA yüksekliği arasındaki ilişki halen gizemini korumaktadır. Bu çalışmada inflamasyon ile PSA yüksekliği arasında istatistiksel bir ilişki saptanmasa da kronik prostatit ile VB3 pozitifliği arasındaki anlamlı korelasyon bu ilişkinin olabileceği hususunu güçlendirmektedir. Bizim sonuçlarımızın gereksiz biyopsiden kaçınmak için yapılacak daha ileri çalışmalar için temel verileri oluşturacağına inanıyoruz.

Keywords

PSA yüksekliği, Prostat kanseri, Kronik prostatit, İki kadeh testi

Investıgatıon of the Relatıonshıp of Two-Glass Test Wıth Prostate Bıopsy and the Presence and Grade of Asymptomatıc Prostate Inflammatıon In Men Wıth Serum Prostate-Specıfıc Antıgen Level Between 2.5-10 Ng/Ml

Abstract

Objective: Prostate-specific antigen (PSA) is a marker used to detect prostate cancer. When high PSA values are detected, a prostate biopsy is performed considering the possibility of prostate cancer. PSA elevation is not specific to prostate cancer, but may also be caused by conditions such as benign prostatic hyperplasia (BPH), urinary tract infection, and chronic prostatitis. Prostate cancer is not detected in approximately 66% of patients undergoing a biopsy, and patients are exposed to unnecessary biopsy and biopsy complications. Chronic prostatitis is detected in approximately 40% of these biopsies. The two-glass test is based on examining urine before and after rectal examination, which is used in diagnosing chronic prostatitis. In this study, we aimed to reveal the two-glass test’s effectiveness in predicting the incidence of prostatitis and inflammation in patients with a PSA value of 2.5-10 ng/ml and who underwent prostate needle biopsy.

Methods: Fifty-two male patients, aged between 50 and 78 years, with PSA values between 2.5 and 10 ng/ml, who applied to our clinic were included in the study. EPS-two-glass test and prostate biopsy were applied to all patients. EPS; is a sample obtained by removing the fluid from the urethra after a prostate massage; VB-3; shows the urine produced by taking about 10 ml of urine voided after massage. EPS and VB3 detect prostate infection. Under the microscope, ≥10 leukocytes were considered significant for prostate inflammation. According to the pathology results, the patients were divided into 3 groups; prostate cancer, BPH, and chronic prostatitis. The chronic prostatitis group was classified according to the histopathological calcification described by Nickel.

Results: In this study, the ratio of chronic prostatitis was found to be 38%. VB3 positivity was found to be statistically significant in the chronic prostatitis group compared to the other groups (p = 0.028). Although there was no statistically significant difference between the prevalence of inflammation and PSA elevation, PSA was found to be higher in the multifocal inflammation subgroup than in the focal inflammation patient group.

Conclusion: The relationship between chronic prostatitis and PSA elevation remains a mystery. Although no statistical relationship was found between inflammation and PSA elevation in this study, the significant correlation between chronic prostatitis and VB3 positivity reinforces the possibility of this relationship. We believe that our results will form the basis for further studies to avoid unnecessary biopsies.

Keywords

PSA elevation, Prostate cancer, Chronic prostatitis, Two glass test

Supporting Institution

yok

References

• 1. Stamey TA, Yang N, Hay AR, McNeal JE, Freiha FS, Redwine E. Prostate-specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med. 1987 8;317(15):909-16.
• 2. Catalona WJ, Smith DS, Ratliff TL, Dodds KM, Coplen DE, Yuan JJ et al. Measurement of prostate-specific antigen in serum as a screening test for prostate cancer. N Engl J Med. 1991 25;324(17):1156-61.
• 3. Benson MC, Whang IS, Olsson CA, McMahon DJ, Cooner WH. The use of prostate specific antigen density to enhance the predictive value of intermediate levels of serum prostate specific antigen. J Urol. 1992;147(3 Pt 2):817-21.
• 4. Dalton DL. Elevated serum prostate-specific antigen due to acute bacterial prostatitis. Urology. 1989;33(6):465.
• 5 - Lee JH, Won Park Y, Woo Lee S, Duck Choi J, Yoon Kang J, Yoo TK. Association between predictors of progression of benign prostatic hyperplasia and moderate-to-severe prostatitis-like symptoms: A propensity score-matched analysis. Prostate Int. 2022;10(2):92-95.
• 6. Emmett L, Buteau J, Papa N, Moon D, Thompson J, Roberts MJ, Rasiah K et al. The Additive Diagnostic Value of Prostate-specific Membrane Antigen Positron Emission Tomography Computed Tomography to Multiparametric Magnetic Resonance Imaging Triage in the Diagnosis of Prostate Cancer (PRIMARY): A Prospective Multicentre Study. Eur Urol. 2021;80(6):682-9.
• 7. Neal DE Jr, Clejan S, Sarma D, Moon TD. Prostate specific antigen and prostatitis. I. Effect of prostatitis on serum PSA in the human and nonhuman primate. Prostate. 1992;20(2):105-11.
• 8. Keetch DW, Andriole GL, Ratliff TL, Catalona WJ. Comparison of percent free prostate-specific antigen levels in men with benign prostatic hyperplasia treated with finasteride, terazosin, or watchful waiting. Urology. 1997;50(6):901-5.
• 9. Nickel JC. Practical approach to the management of prostatitis. Tech Urol. 1995;1(3):162-7.
• 10. Nickel JC. The Pre and Post Massage Test (PPMT): a simple screen for prostatitis. Tech Urol. 1997;3(1):38-43. 11. Hasui Y, Marutsuka K, Asada Y, Ide H, Nishi S, Osada Y. Relationship between serum prostate specific antigen and histological prostatitis in patients with benign prostatic hyperplasia. Prostate. 1994;25(2):91-6.
• 12. Carver BS, Bozeman CB, Williams BJ, Venable DD. The prevalence of men with National Institutes of Health category IV prostatitis and association with serum prostate specific antigen. J Urol. 2003;169(2):589-91.
• 13. Hoekx L, Jeuris W, Van Marck E, Wyndaele JJ. Elevated serum prostate specific antigen (PSA) related to asymptomatic prostatic inflammation. Acta Urol Belg. 1998;66(3):1-2.
• 14. Tchetgen MB, Oesterling JE. The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigen concentration. Urol Clin North Am. 1997;24(2):283-91.
• 15. McNeal JE. Regional morphology and pathology of the prostate. Am J Clin Pathol. 1968;49(3):347-57. 16. Schmidt JD, Patterson MC. Needle biopsy study of chronic prostatitis. J Urol. 1966;96(4):519-33.
• 17. Brawn PN, Speights VO, Kuhl D, Riggs M, Spiekerman AM, McCord RG etal. Prostate-specific antigen levels from completely sectioned, clinically benign, whole prostates. Cancer. 1991 1;68(7):1592-9.
• 18.Ludwig M, Schroeder-Printzen I, Lüdecke G, Weidner W. Comparison of expressed prostatic secretions with urine after prostatic massage--a means to diagnose chronic prostatitis/inflammatory chronic pelvic pain syndrome. urology. 2000;55(2):175-7.
• 19. Lee AG, Choi YH, Cho SY, Cho IR. A prospective study of reducing unnecessary prostate biopsy in patients with high serum prostate-specific antigen with consideration of prostatic inflammation. Korean J Urol. 2012;53(1):50-3.
• 20. Taha DE, Aboumarzouk OM, Koraiem IO, Shokeir AA. Antibiotic therapy in patients with high prostate-specific antigen: Is it worth considering? A systematic review. Arab J Urol. 2019 25;18(1):1-8.
• 21. Kwak C, Ku JH, Kim T, Park DW, Choi KY, Lee E et al. Effect of subclinical prostatic inflammation on serum PSA levels in men with clinically undetectable prostate cancer. Urology. 2003;62(5):854-9.
• 22. Nadler RB, Humphrey PA, Smith DS, Catalona WJ, Ratliff TL. Effect of inflammation and benign prostatic hyperplasia on elevated serum prostate specific antigen levels. J Urol. 1995;154(2 Pt 1):407-13.
• 23. Okada K, Kojima M, Naya Y, Kamoi K, Yokoyama K, Takamatsu T et al.. Correlation of histological inflammation in needle biopsy specimens with serum prostate- specific antigen levels in men with negative biopsy for prostate cancer. Urology. 2000;55(6):892-8.
• 24. Potts JM. Prospective identification of National Institutes of Health category IV prostatitis in men with elevated prostate specific antigen. J Urol. 2000;164(5):1550-3.
• 25. Ornstein DK, Smith DS, Humphrey PA, Catalona WJ. The effect of prostate volume, age, total prostate specific antigen level and acute inflammation on the percentage of free serum prostate specific antigen levels in men without clinically detectable prostate cancer. J Urol. 1998;159(4):1234-7.
• 26. Moon TD, Clejan S, Neal DE Jr. Prostate specific antigen and prostatitis. II. PSA production and release kinetics in vitro. Prostate. 1992;20(2):113-6.