Demir Kadir, Tarhan Fatih, Orçun Asuman, Aslan Hasan, Türk Akif
Department of Urology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey.
Biochemistry Laboratory, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey.
Turk J Urol. 2014 Mar;40(1):40-5. doi: 10.5152/tud.2014.03704.
The aim of this study is to evaluate the effect of ejaculation on serum total, free and complex prostate-specific antigen (PSA) levels and their effect on biopsy decisions.
Our study includes 47 men older than 45 years with symptomatic benign prostatic hyperplasia (BPH). Patients' PSA levels were under 2.5 ng/mL, and there were no known conditions to preclude ejaculation. Eight patients with similar demographic, and clinical characteristics were chosen as a control group. With three days of sexual abstinence, blood samples were drawn for the measurement of baseline PSA levels, and then the patients were told to ejaculate. One, 5, 24 and 72 hours after ejaculation, serum total, free and complexed PSA levels were measured. Serum PSA sampling was performed at the same intervals in the control group without ejaculation.
The mean age of the patients was 59.13±1.38 years in the study group, and 63.75±3.13 years in the control group. The mean international prostate symptom scores (IPSS) were 11.78±1.12 and 11.63±3.32 in the study, and the control groups, respectively. The mean baseline total, free, and complexed PSA values were 1.07±0.09, 0.31±0.03, and 0.71±0.08 ng/mL, respectively. In the study group, total PSA value was found to be 1.29±0.12 ng/mL (p=0.008) at first hour after ejaculation, and this change was statistically significant when compared with baseline values. Mean total PSA level rose up to 1.28±0.13 ng/mL (p=0.05) by the 5(th) hour after ejaculation, but this change was not statistically significant relative to the baseline values. Mean free PSA level rose after the first hour postejaculation to 0.37±0.04 ng/mL (p=0.01) and after the fifth hour postejaculation to 0.37±0.04 ng/mL (p=0.002), and these changes were statistically significant relative to the baseline values. There were no statistically significant changes at the other sampled times as for the total, free or complexed PSA serum levels. When all three values were considered individually, in only 2.12% of the patients, biopsy decisions could be affected by the elevation in PSA levels.
When the PSA value is borderline with respect to biopsy decisions, the effect of ejaculation on serum PSA levels may be clinically important. In these patients, ejaculation must be questioned, and repeated. PSA levels should be evaluated 24 hours after ejaculation. There were no statistically significant changes in the levels of complex PSA values. Further studies are needed to clarify the relationship between complexed PSA and ejaculation.
本研究旨在评估射精对血清总前列腺特异性抗原（PSA）、游离PSA及复合PSA水平的影响，以及这些影响对活检决策的作用。
我们的研究纳入了47例年龄超过45岁、有症状的良性前列腺增生（BPH）男性患者。患者的PSA水平低于2.5 ng/mL，且不存在已知的妨碍射精的情况。选取8例具有相似人口统计学和临床特征的患者作为对照组。在禁欲三天后，采集血样以测定基线PSA水平，然后告知患者射精。射精后1小时、5小时、24小时和72小时，测定血清总PSA、游离PSA及复合PSA水平。对照组在不射精的情况下以相同间隔进行血清PSA采样。
研究组患者的平均年龄为59.13±1.38岁，对照组为63.75±3.13岁。研究组和对照组的平均国际前列腺症状评分（IPSS）分别为11.78±1.12和11.63±3.32。基线时总PSA、游离PSA及复合PSA的平均水平分别为1.07±0.09 ng/mL、0.31±0.03 ng/mL和0.71±0.08 ng/mL。在研究组中，射精后第1小时总PSA值为1.29±0.12 ng/mL（p = 0.008），与基线值相比，这种变化具有统计学意义。射精后第5小时，总PSA平均水平升至1.28±0.13 ng/mL（p = 0.05），但相对于基线值，这种变化无统计学意义。射精后第1小时游离PSA平均水平升至0.37±0.04 ng/mL（p = 0.01），射精后第5小时升至0.37±0.04 ng/mL（p = 0.002），相对于基线值，这些变化具有统计学意义。在其他采样时间，总PSA、游离PSA或复合PSA血清水平均无统计学意义的变化。当分别考虑这三个值时，仅2.12%的患者活检决策可能受PSA水平升高的影响。
当PSA值对于活检决策处于临界值时，射精对血清PSA水平的影响可能具有临床重要性。对于这些患者，必须询问并重复射精情况。应在射精后24小时评估PSA水平。复合PSA水平无统计学意义的变化。需要进一步研究以阐明复合PSA与射精之间的关系。
