Kobayashi Minoru, Kijima Toshiki, Yashi Masahiro, Kamai Takao
Department of Urology, Utsunomiya Memorial Hospital, Tochigi, Japan.
Department of Urology, Dokkyo Medical University, Tochigi, Japan.
Prostate Int. 2023 Mar;11(1):27-33. doi: 10.1016/j.prnil.2022.08.001. Epub 2022 Aug 24.
It is common to repeat prostate-specific antigen (PSA) measurements for men with PSA elevation before prostate biopsy. In this scenario, they may have considerable psychological distress in fear of the presence of cancer until retests. We assessed possible clinical factors causing transient PSA rise and explored the parameters predictive of subsequent PSA change.
As interfering conditions, the history of ejaculation, bicycling, and any types of infections were assessed using the questionnaire. The pattern of PSA change was compared in association with the various clinical factors. Predictive significance of PSA kinetics such as coefficient of variation (CV) and PSA velocity (PSAV) for PSA values at retest was evaluated.
The rate of reversion to the normal range was 38.3% at retest. The rate of 12.8% of men showed a large increase by ≥20%, whereas 38.2% of men showed a large decline by ≥20% from the baseline. Men with younger age (≤60 years), small prostate (<20 cc), and prior history of ejaculation or infections showed significantly larger PSA decrease than their counterparts. Those with large CV or PSAV before the baseline more frequently showed PSA decrease below the age-specific cutoff or decline by ≥10% from the baseline at retest. These parameters associated with PSA kinetics had independent predictive values for relevant PSA change at retest.
Ejaculation and any types of infections should be avoided before PSA tests. Men with large PSA fluctuation before the baseline are likely to show a significant PSA decrease at retest. This predictive information may help both physicians to determine whether to proceed to an immediate biopsy and patients to reduce their psychological burden.
对于前列腺特异抗原（PSA）升高的男性，在前列腺活检前重复进行PSA检测很常见。在这种情况下，他们在复检之前可能会因担心患癌而有相当大的心理压力。我们评估了导致PSA短暂升高的可能临床因素，并探讨了预测后续PSA变化的参数。
作为干扰因素，通过问卷评估射精史、骑自行车情况和任何类型的感染史。将PSA变化模式与各种临床因素相关联进行比较。评估PSA动力学指标如变异系数（CV）和PSA速度（PSAV）对复检时PSA值的预测意义。
复检时恢复到正常范围的比例为38.3%。12.8%的男性PSA大幅升高≥20%，而38.2%的男性PSA较基线大幅下降≥20%。年龄较小（≤60岁）、前列腺较小（<20立方厘米）以及有射精或感染史的男性PSA下降幅度明显大于其对应人群。基线前CV或PSAV较大的男性在复检时更频繁地出现PSA下降至年龄特异性临界值以下或较基线下降≥10%。这些与PSA动力学相关的参数对复检时相关PSA变化具有独立的预测价值。
PSA检测前应避免射精和任何类型的感染。基线前PSA波动较大的男性在复检时可能会出现显著的PSA下降。这一预测信息可能有助于医生决定是否立即进行活检，也有助于患者减轻心理负担。
