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Can kidney problems cause high PSA?

In conclusion our study suggests that CKD stage V does not have significant impact on total PSA levels. Those individuals with abnormal values of PSA either had or were at risk to develop prostatic disease.

sjkdt.org - Prostate specific antigen levels in pre-dialysis chronic kidney disease ...

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LETTER TO THE EDITOR Year : 2010 | Volume : 21 | Issue : 2 | Page : 354-356 Prostate specific antigen levels in pre-dialysis chronic kidney disease patients Shahid Hussain1, Ghulam Abbas2

1 National Institute of Kidney Diseases, Shaikh Zayed Medical Complex, Lahore, Pakistan

2 Department of Nephrology, Bahawalpur Victoria Hospital, Quaid -E- Azam Medical College, Bahawalpur, Pakistan Hussain S, Abbas G. Prostate specific antigen levels in pre-dialysis chronic kidney disease patients. Saudi J Kidney Dis Transpl 2010;21:354-6

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Hussain S, Abbas G. Prostate specific antigen levels in pre-dialysis chronic kidney disease patients. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2023 Jan 24];21:354-6. Available from: https://www.sjkdt.org/text.asp?2010/21/2/354/60212 To the Editor, The prostate specific antigen (PSA) remains the best and most widely used tumor marker for prostate in clinical practice these days. [1],[2] It is a glycoprotein with a molecular weight of 33KD. PSA is commonly used in the diagnosis and follow-up of prostate disease especially prostatic cancer. [3],[4] Acid phosphatase (ACP) and prostatic acid phosphatase (ACP prost) have also been used in the past to detect prostatic disease. [5] Since PSA was introduced into clinical practice in 1986, the early diagnosis and management of prostate cancer has been revolutionized and much has been learnt about the strengths and weaknesses of this assay. [6] The PSA test is the most effective test currently available for the early detection, diagnosis and follow-up of prostate cancer in kidney disease (CKD) patients. [7],[8],[9] Men with chronic renal failure evaluated for transplantation are often tested for PSA to detect prostate cancer. Middle and higher molecular weight substances that are filtered through kidney accumulate in the body in CKD. Therefore, it was suspected that PSA level may be higher in CKD making the diagnostic validity of PSA and ACP prost uncertain in CKD patients. 44 men above the age 50 having a creatinine clearance < 15 mL/min but not yet on dialysis and no clinical suggestion of prostate disease were recruited from pre-dialysis nephrology clinic. 25 men age > 50 years: 7 with definite history of prostate disease (control 1) and 18 with no history of prostate disease and followed up in urology clinic for other than prostate disease (control 2) were included as controls. Total PSA was measured in serum with immunoradiometric assay technique (TANDEM-R PSA). Total acid phosphatase and prostatic acid phosphatase were measured by colorimetric method. SPSS 13 was used for all analysis. The mean age of the patient was 62 ± 8 (50 - 92) years in the study group [Table 1]. Only five patients out of 44 had raised PSA levels above the reference range (< 4.1 ug/L). Further detailed investigations of these patients showed them to have prostate disease [Table 2]. Mean total acid phosphatase was was not significantly different among the groups (P value 0.174). However, as expected prostatic acid phosphatase was significantly higher (P value 0.01) in control 1 group [Table 1]. The incidence of malignancy is increased in chronic kidney disease especially patients on hemodialysis compared to general population. [10] The symptoms of prostatic disease may be minimal or absent in patients with chronic kidney disease since most of the patients are oliguric and eventually may become anuric. Early detection of prostatic malignancy is of great importance as it can decrease the death rate of prostatic cancer by one third. [11] Patients with advanced CKD (CKD V) may be candidates for renal transplantation with subsequent introduction of immunosupression and exclusion of prostatic cancer is important in this population. There have been conflicting reports about the validity of tPSA levels in patients with CKD. [9],[12],[13],[14] Our results however, show that the recommended reference ranges for tPSA are also applicable to patients with advanced kidney disease (CKD V) for the detection of prostatic diseases, both benign prostatic hypertrophy (BPH) and prostatic cancer. Overall levels of tPSA and ACP in our study group were similar to controls with no evidence of prostatic disease confirming the lack of sensitivity of ACP in diagnosing prostate cancer. [5],[15]

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Chronic kidney disease and benign prostatic hypertrophy are both common in elderly males with a possibility of bladder outlet obstruction as a contributing cause. [16] In our study group two patients turned out to have BPH and other three had prostatic cancer. The measurement of tPSA is a helpful tool in the diagnosis and follow up of patients. Although there are conflicting reports regarding the levels of tPSA in hemodialysis patients, nevertheless, its levels are not affected significantly by either method of dialysis or type of membrane used during hemodialysis. [8],[9],[13],[17],[18] Some studies have determined that free PSA (fPSA)levels may be significantly higher in dialysis patients compared to tPSA levels and should help in differentiating benign from malignant disease. [9],[17],[19] As far as we know there are no published studies in literature to determine the level of PSA in males over the age of 50 at different degree of renal failure. [20] Our study therefore is important to confirm the use of tPSA for diagnosis of prostate cancer and benign prostatic hypertrophy in patients with CKD stage V who have not started dialysis yet compared to controls. ACP prostate was done due to its historic use, low cost and easy availability in most laboratories although it has never been proven to be a valid tumor marker for prostate. The limitations of our study are relatively small number of patients studied and our inability to do fPSA levels due to nonavailability of these tests in our laboratory; although recent data showed the lack of sensitivity of fPSA in detecting prostatic disease. [20] In conclusion our study suggests that CKD stage V does not have significant impact on total PSA levels. Those individuals with abnormal values of PSA either had or were at risk to develop prostatic disease.

References

1. Carroll P, Coley C, McLeod D, et al. Prostatespecific antigen best practice policy--part II: Prostate cancer staging and post-treatment follow-up. Urology 2001;57:225-9. [ PUBMED ] 2. Higashihara E, Nutahara K, Kojima M, et al. Significance of serum free prostate specific antigen in the screening of prostate cancer. J Urol 1996;156:1964-8. [ PUBMED ] 3. Polascik TJ, Oesterling JE, Partin AW. Prostate specific antigen: A decade of discovery-what we have learned and where we are going. J Urol 1999;162:293-306. [ PUBMED ] 4. Partin AW, Oesterling JE. Clinical usefulness of prostatic specific antigen: Update 1994. J Urol 1994;152:1358-68. [ PUBMED ] 5. Ercole CJ, Lange PH, Mathisen M, et al. Prostatic specific antigen and prostatic acid phosphatase in the monitoring and staging of patients with prostatic cancer. J Urol 1987;138: 1181-4. [ PUBMED ] 6. Reissigl A, Bartsch G. Prostate-specific antigen as a screening test. The Austrian experience. Urol Clin North Am 1997;24:315-21. 7. Oesterling JE. Prostatic specific antigen: A critical assessment of the most useful tumour marker for adenocarcinoma of the prostate. J Urol 1991;145:907-23. [ PUBMED ] 8. Tzanakis I, Kazoulis S, Girousis N, et al. Prostate-specific antigen in hemodialysis patients and the influence of dialysis in its levels. Nephron 2002;90:230-3. [ PUBMED ] 9. Djavan B, Shariat S, Ghawidel K, et al. Impact of chronic dialysis on serum PSA, free PSA, and free/total PSA ratio: Is prostate cancer detection compromised in patients receiving long-term dialysis? Urology 1999;53:1169-74. [ PUBMED ] 10. Marple JT, MacDougall M. Development of malignancy in the end stage renal disease patients. Semin Nephrol 1993;13:306-14. [ PUBMED ] 11. Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2008. CA Cancer J Clin 2008;58:71-96. [ PUBMED ] 12. Morton JJ, Howe SF, Lowell JA, Stratta RJ, Taylor RJ. Influence of end stage renal disease and renal transplantation on serum prostatic antigen. Br J Urol 1995;75:498-501. [ PUBMED ] 13. Sasagawa I, Nakada T, Hashimoto T, et al. Serum prostatic acid phosphatase, gammaseminoprotein and prostatic specific antigen in hemodialysis patients. Urol Int 1992;48:181-3. [ PUBMED ] 14. Arick N, Adam B, Akpolat T, Hasil K, Tabak S. Serum tumour markers in renal failure. Int Urol Nephrol 1996;28:601-4. 15. Watson RA, Tang DB. The predictive value of prostatic acid phosphatase as a screening test for prostatic cancer. N Eng J Med 1980;303: 497-9. 16. Rule AD, Jacobson DJ, Roberts RO, et al. The association between benign prostatic hyperplasia and chronic kidney disease in communitydwelling men. Kidney Int 2005;67:2376-82. [ PUBMED ] 17. Bruun L, Bjork T, Lilja H, Becker C, Gustafsson O, Christensson A. Percent-free prostate specific antigen is elevated in men on haemodialysis or peritoneal dialysis treatment. Nephrol Dial Transplant 2003;18:598-602. 18. Catalona WJ, Partin AW, Slawin KM, et al. Use of the percentage of free prostate-specific antigen to enhance differentiation of prostate cancer from benign prostatic disease: A prospective multicenter clinical trial. JAMA 1998; 279:1542-7. [ PUBMED ] 19. Douville P, Tiberi M. Effect of terminal renal failure on the ratio of free to total prostatespecific antigen. Tumor Biol 1998;19:113-7. 20. Bruun L, Savage C, Cronin AM, Hugosson J, Lilja H, Christensson A. Increase in percent free prostate-specific antigen in men with chronic kidney disease. Nephrol Dial Transplant 2009; 24(4):1238-41.

Shahid Hussain

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National Institute of Kidney Diseases, Shaikh Zayed Medical Complex, Lahore

Pakistan

PMID: 20228531

Tables

[Table 1], [Table 2]

sjkdt.org - Prostate specific antigen levels in pre-dialysis chronic kidney disease ...

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