title: The clinical value of PSA increase during intravesical adjuvant therapy for nonmuscle-invasive bladder cancer.
abstract: BACKGROUND
  Prostatic Specific Antigen (PSA), Bacillus Calmette-Guerin (BCG) increase after intravesical BCG has been reported. The need of prostate biopsy in these patients is object of debate. The aim of our study was to evaluate the effect of intravesical therapy on PSA after transurethral resection (TUR) of nonmuscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  Patients undergoing intravesical chemotherapy or immunotherapy for NMIBC were entered. PSA was measured before TUR, before the first and after the sixth instillation, 30 and 90 days after the last instillation. Patients with PSA ≥4 ng/ml or palpable prostate nodule were excluded.
  
  
  RESULTS
  Out of 130 patients, 105 were evaluable. PSA increase (mean: 7.15 ng/ml) was detected after TUR and before intravesical therapy in 14 patients (13.3%). Of the remaining 91 patients, 65 (71.4%) received chemotherapy and 26 (28.6%) BCG. Median PSA before and during therapy was 1.80 and 1.97 ng/ml, with a 36% median increase in 66 patients (72.5%) (p = 0.13). No statistically significant difference emerged between chemotherapy and BCG (p = 0.22). PSA higher than 4 ng/ml was detected in six (6.3%) and two (2.1%) patients after chemotherapy and BCG, respectively, and was no more evident at 90 days.
  
  
  CONCLUSIONS
  PSA increase due to intravesical therapy is rare and usually not clinically significant. PSA rising above 4 ng/ml during intravesical treatment was evident only in 8% of patients. PSA before TUR should be available and considered as the basal value. Elevated PSA detected during therapy should be monitored and biopsy proposed only if persisting more than 3 months after the end.
authors: Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo - Italy.
authors: Vincenzo
authors: V
authors: Serretta
authors: Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo - Italy.
authors: Cristina Scalici
authors: CS
authors: Gesolfo
authors: Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo - Italy.
authors: Fabrizio
authors: F
authors: Di Maida
authors: Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo - Italy.
authors: Giovanni
authors: G
authors: Caruana
authors: Department of Urology, University Vita Salute San Raffaele, Milan - Italy.
authors: Lorenzo
authors: L
authors: Rocchini
authors: Department of Urology, University Vita Salute San Raffaele, Milan - Italy.
authors: Marco
authors: M
authors: Moschini
authors: Department of Urology, University Vita Salute San Raffaele, Milan - Italy.
authors: Renzo
authors: R
authors: Colombo
authors: Department of Surgical, Oncological and Stomatological Sciences, Section of Urology, University of Palermo, Palermo - Italy.
authors: Alchiede
authors: A
authors: Simonato
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001500:BCG Vaccine / Q000008:administration & dosage; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D017430:Prostate-Specific Antigen / Q000097:blood*; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000276:Adjuvants, Immunologic; D000970:Antineoplastic Agents; D001500:BCG Vaccine; D017430:Prostate-Specific Antigen