Medications and surgical interventions for benign prostatic hyperplasia are potential confounders of prostate-specific antigen.
Prostate-specific antigen (PSA) is the most widely used marker for prostate cancer (CaP) screening and monitoring benign prostatic hyperplasia (BPH) progression. However, lack of an established abnormal threshold and the presence of other benign processes confound the interpretation of PSA levels. Many factors besides inflammation, trauma, and instrumentation can influence PSA levels; specifically, BPH and its associated medical and surgical therapies frequently complicate the interpretation of this serum blood test. For example, the commonly used 5 alpha reductase inhibitor (5ARI) medications directly affect PSA levels by decreasing prostate volume. The amount of time and potentially even the 5ARI formulary a patient is administered has been implicated to directly impact the degree of reduction in PSA (a proxy for prostate volume). In addition, each of the currently available surgical procedures for BPH appears to remove varying amounts of prostatic adenoma. This directly confounds CaP screening because each procedure is associated with a relatively specific postoperative nadir PSA level, and PSA kinetics are not well described in the literature. Taken together, it is important for clinicians to comprehend that BPH and its associated medical and surgical interventions should directly influence their interpretation of PSA and PSA velocity when screening for CaP or following BPH progression.
Modi
Parth
P
Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA.
Helfand
Brian T
BT
McVary
Kevin T
KT
D015986:Confounding Factors, Epidemiologic; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
D017430:Prostate-Specific Antigen
Int Braz J Urol. 2009 Sep-Oct;35(5):521-9; discussion 530-2
19860930
J Urol. 2006 May;175(5):1657-62
16600723
J Urol. 1996 Sep;156(3):1035-9
8709302
Urology. 2009 Nov;74(5):1105-10
19773035
Int J Impot Res. 2008 Dec;20 Suppl 3:S19-26
19002120
Urology. 1998 Aug;52(2):195-201; discussion 201-2
9697781
J Urol. 2005 Sep;174(3):877-81
16093979
J Urol. 2009 Nov;182(5):2232-41
19781717
Eur Urol. 2008 Jan;53(1):160-6
17869409
J Urol. 2008 Jul;180(1):241-5; discussion 245
18499180
Urology. 1999 Mar;53(3):581-9
10096388
J Urol. 1996 Jan;155(1):3-9
7490873
Int Braz J Urol. 2008 Jan-Feb;34(1):41-8
18341720
Urology. 2009 Jul;74(1):177-83
19428074
Eur Urol. 2007 Nov;52(5):1456-63
17499427
J Natl Cancer Inst. 2006 Apr 19;98(8):529-34
16622122
BJU Int. 2006 Jan;97(1):85-9
16336334
J Endourol. 2005 Jun;19(5):550-4
15989443
J Urol. 2006 Sep;176(3):868-74
16890642
J Urol. 2002 Oct;168(4 Pt 1):1465-9
12352419
J Clin Oncol. 2007 Jul 20;25(21):3076-81
17634486
J Natl Cancer Inst. 2006 Nov 1;98(21):1521-7
17077354
J Urol. 2006 Dec;176(6 Pt 1):2557-61; discussion 2561
17085158