Cevik I, Türkeri L N, Ozveri H, Ilker Y, Akdaş A
Marmara University School of Medicine, Department of Urology, Istanbul, Turkey.
Eur Urol. 1996;29(4):403-6. doi: 10.1159/000473787.
Prostate-specific antigen (PSA) is widely used as a tumor marker in the early detection of prostate cancer. However, its value is limited by several factors such as not being specific for the cancer tissue, diurnal variations of the secretion, and changes in the serum levels observed following rectal manipulations. The effect of digital rectal examination (DRE) on serum PSA levels is still debatable.
A prospective study is conducted by utilizing the IRMA count (monoclonal) PSA assay in order to determine the effect of DRE on PSA serum levels. A total of 50 men (median age 61, range 42-75 years) who presented to our outpatient clinic for the first time with lower urinary tract outflow obstruction symptoms were included in this study. Further evaluation revealed prostate cancer in 5 patients (10%) and benign prostate hyperplasia in the others. Blood samples were drawn for a PSA assay from all patients prior to and 30 min and 24 h following DRE (PSA 1-3).
The mean PSA values prior to and 30 min and 24 h following DRE were 4.09 +/- 0.67 range 0.2-19.47) ng/ml, 4.50 +/- 0.63 (0.15-17.75), and 4.28 +/- 0.68 (0.23-24.12) ng/ml, respectively. The median PSA levels for PSA 1, PSA 2, and PSA 3 were 2.49 +/- 4.74, 3.22 +/- 4.48, and 2.62 +/- 4.82 ng/ml, respectively. Although, there was a statistically significant increase in serum PSA levels 30 min after DRE, the clinical significance of this increase in PSA values with a mean difference of 0.4 ng/ml remains to be clarified.
Although the effect of DRE on PSA levels does not appear to be clinically significant, in order to prevent any confusion, it may be the best approach to perform DRE after obtaining serum for PSA analysis.
前列腺特异性抗原（PSA）作为一种肿瘤标志物，在前列腺癌的早期检测中被广泛应用。然而，其价值受到多种因素的限制，如对癌组织缺乏特异性、分泌的昼夜变化以及直肠操作后血清水平的改变。直肠指检（DRE）对血清PSA水平的影响仍存在争议。
采用免疫放射分析（IRMA）计数法（单克隆PSA检测）进行前瞻性研究，以确定DRE对PSA血清水平的影响。本研究纳入了50名首次因下尿路流出道梗阻症状前来我院门诊就诊的男性（中位年龄61岁，范围42 - 75岁）。进一步评估发现5例患者（10%）患有前列腺癌，其余患者为良性前列腺增生。在DRE前、DRE后30分钟和24小时（PSA 1 - 3），对所有患者进行采血以检测PSA。
DRE前、DRE后30分钟和24小时的平均PSA值分别为4.09±0.67（范围0.2 - 19.47）ng/ml、4.50±0.63（0.15 - 17.75）ng/ml和4.28±0.68（0.23 - 24.12）ng/ml。PSA 1、PSA 2和PSA 3的中位PSA水平分别为2.49±4.74、3.22±4.48和2.62±4.82 ng/ml。尽管DRE后30分钟血清PSA水平有统计学意义的升高，但平均差异为0.4 ng/ml的PSA值升高的临床意义仍有待阐明。
虽然DRE对PSA水平的影响似乎没有临床意义，但为避免混淆，在获取血清进行PSA分析后再进行DRE可能是最佳方法。
