LETTER
Marked Elevation of Prostate-Specific Antigen after Prolonged Prostatic Trauma
Fred E. Husserl
1 November 1993 | Volume 119 Issue 9 | Page 956
TO THE EDITOR:
Prostate-specific antigen (PSA), a glycoprotein produced by prostatic epithelial cells with low individual and no circadian variability, is increased in benign prostatic hypertrophy and prostatic carcinoma [1]. Elevations greater than 10.0 ng/dL have been correlated with the presence of prostate cancer (specificity approaching 92%) [2]. I describe the occurrence of a marked, although transient, increase in the PSA level in association with moderately severe, continuous prostatic trauma.
A 66-year-old man with diabetes and essential hypertension was treated with nifedipine, glyburide, and aspirin. In July 1992, physical examination showed a slightly enlarged prostate gland (40 g) without nodules. The PSA level was 2.9 ng/dL. On 8 September, he saw a urologist for frequency, dysuria, and perineal discomfort after a 70-mile ride in a small skiff in bad weather, during which he sustained repeated severe perineal trauma. His prostate felt slightly boggy, but prostatic secretions and urinalysis were normal. The PSA level was 76 ng/dL, with the same result on re-examination of that sample a week later. On 21 October, the PSA level was 2.7 ng/dL. On 16 November, examination showed a slightly enlarged, nontender prostate; the PSA level was 2.8 ng/dL; results of rectal examination and the PSA level have remained unchanged through April 1993.
Increases in the PSA level have been reported with severe trauma (surgery) and in 25% of patients after biopsy [3]. The PSA level has not been reported to increase with digital examination [4] or rectal ultrasound [3], although a minor increase lasting less than 24 hours has been reported with massage [5].
In our patient, continued trauma to the prostate gland may have caused breakdown of normal gland architecture, facilitating diffusion of large amounts of PSA into the circulation. A careful history for possible prostatic trauma is warranted when unexpected elevation of the PSA is encountered.
1. Price A, Attwood SE, Grant JB, Gray TA, Moore KT. Measurement of prostate-specific antigen and prostatic acid phosphatase concentrations in serum before and 1-42 days after transurethral resection of the prostate and orchidectomy. Clin Chem. 1991; 37:859-63.
2. Cooner WH, Mosley BR, Rutherford CL Jr, Beard JH, Pond HS, Terry WJ, et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol. 1990; 143:1146-52; discussion, 1152-4.
3. Yuan JJ, Coplen DE, Petros JA, Figenshau RS, Ratliff TL, Smith DS, et al. Effects of rectal examination, prostatic massage, ultrasonography and needle biopsy on serum prostate specific antigen levels. J Urol. 1992; 147:810-4.
4. Brawer MK, Schifman RB, Ahmann FR, Ahmann ME, Coulis KM. The effect of digital rectal examination on serum levels of prostatic-specific antigen. Arch Pathol Lab Med. 1988; 112:1110-2.
5. el-Shirbiny AM, Nilson T, Pawar HN. Serum prostate-specific antigen: hourly change/24 hours compared with prostatic acid phosphatase. Urology. 1990; 35:88-92.
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