Morton J J, Howe S F, Lowell J A, Stratta R J, Taylor R J
Department of Surgery, University of Nebraska Medical Center, Omaha, USA.
Br J Urol. 1995 Apr;75(4):498-501. doi: 10.1111/j.1464-410x.1995.tb07272.x.
To evaluate the effect of dialysis and kidney transplantation on serum prostate-specific antigen (PSA) levels, and to compare these results with those from normal age-matched controls. In addition, to evaluate the efficacy of PSA and digital rectal examination (DRE) for detection of prostate cancer in patients on dialysis and following kidney transplantation.
Between January 1990 and July 1993 all men in the transplant programme over the age of 40 years who were undergoing pre-transplant evaluation or post-transplant follow-up underwent a yearly DRE and PSA evaluation. Twelve patients were evaluated pre-transplant and 70 patients were evaluated post-transplant. A total of 136 PSA levels were obtained (1.7 per patient). Patients with suspicious findings underwent further evaluation with transrectal ultrasound and biopsies if indicated. Controls were patients without known prostate cancer who had been evaluated in a Prostate Cancer Awareness Clinic.
The average PSA values in the study groups were unaffected by either dialysis or transplantation when compared with age-matched controls. In addition, 12 patients who had been on dialysis at the time of their initial evaluation and who subsequently underwent transplantation did not show any difference in their average PSA values pre- or post-transplant. Three patients (4%) were found to have prostate cancer and two underwent radical retropubic prostatectomy. They are free of disease 24 and 36 months post-operatively and neither has experienced any decline in renal function. Immunosuppression was not modified.
Transplantation and dialytic therapy do not appear to affect clinical serum PSA levels. PSA and DRE appear to be equally valid for detection of prostate cancer in patients on dialysis and post-transplant when compared with the general population. Finally, radical prostatectomy appears to be a safe and feasible treatment option in this group of patients.
评估透析和肾移植对血清前列腺特异性抗原（PSA）水平的影响，并将这些结果与年龄匹配的正常对照组进行比较。此外，评估PSA和直肠指检（DRE）在透析患者和肾移植后患者中检测前列腺癌的疗效。
1990年1月至1993年7月期间，移植项目中所有40岁以上接受移植前评估或移植后随访的男性每年接受一次DRE和PSA评估。12例患者在移植前接受评估，70例患者在移植后接受评估。共获得136个PSA水平（每位患者1.7个）。有可疑发现的患者如有指征则接受经直肠超声和活检进一步评估。对照组为在前列腺癌宣传诊所接受评估且无已知前列腺癌的患者。
与年龄匹配的对照组相比，研究组的平均PSA值不受透析或移植的影响。此外，12例在初次评估时接受透析且随后接受移植的患者，其移植前后的平均PSA值没有差异。3例患者（4%）被发现患有前列腺癌，其中2例接受了根治性耻骨后前列腺切除术。他们术后24个月和36个月无疾病，肾功能均未下降。免疫抑制未改变。
移植和透析治疗似乎不影响临床血清PSA水平。与普通人群相比，PSA和DRE在透析患者和移植后患者中检测前列腺癌似乎同样有效。最后，根治性前列腺切除术在这组患者中似乎是一种安全可行的治疗选择。
