Prostate-specific antigen alterations after open prostatectomy / Alterações do antígeno prostático específico após prostatectomia aberta

Autor Principal: Armando José Gabriel
Tipo: Teses/dissertações
Idioma: Português
Publicado em: 2005
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INTRODUCTION: Benign prostatic hyperplasia (BPH), a common aging male disease, is associated with lower urinary tract symptoms that may affect overall quality of life.

Open prostatectomy is one of the treatment options.

Prostate-specific antigen (PSA) specificity for prostate cancer is impaired because patients with BPH may have elevated PSA.

The PSA evolution after open prostatectomy is the objective of this study, particularly, in patients with elevated PSA before operation.

Methods: A prospective study was made with 130 patients undergoing open prostatectomy for BPH from July 2000 to September 2003 at HCFMUSP.

Patients were divided into two study groups by PSA cut-off value.

Patients with PSA >= 4,0 ng/ml integrated case group.

Patients with PSA <4,0ng/ml integrated control group.

Digital rectal examination and PSA were repeated after six to 12 months after operation.

Biopsy was performed in patients with altered digital rectal examination, PSA >= 4,0ng/ml or PSA reduction less than 70%.

Results: Mean patient age was 71,18 years.

Total PSA average value was 10,81ng/ml.

The mean prostatic volume and adenoma weight was 122,91cm³ and 76,54g, respectively.

42,31% (55/130) of patients had an indwelling catheter.

Digital rectal examination was altered in 11,54% (15/130) of patients.

Pathologic examinations of the prostatic specimens showed chronic prostatitis in 49,23% (64/130) of them.

PSA was elevated in 76,15% (99/130) of patients.

They composed the case group.

It was not found any factor between study groups that showed significant difference to justify the elevated PSA.

Incidental prostate cancer was detected in 6,15% (8/130) of patients.

The mean PSA reduction was 81,13% 10,1 months after open prostatectomy.

The mean PSA reduction was 85,16% and 67,01% for case group and control group patients, respectively (p = 0,004).

PSA average value was 1,38ng/ml 10,1 months after open prostatectomy.

PSA average value was 1,56ng/ml and 0,73ng/ml for case group and control group patients, respectively (p = 0,001).

Only 6,56% (8/122) of patients had PSA >= 4,0ng/ml after open prostatectomy.

It was observed statistical correlation between adenoma weight and PSA change (r = 0,262, p = 0,004).

Prostate cancer was detected in 4,1% (5/122) of patients.

All of them had elevated PSA after operation and belonged to case group.

Conclusions: Most of patients had preoperative elevated PSA.

It was observed an important PSA reduction 10,1 months after open prostatectomy.

Patients with preoperative elevated PSA had more important reduction but higher postoperative PSA values than patients with preoperative normal PSA.