P 02. Inreased serum prostate - specific antigen due to benign prostatic hyperplasia with chronic prostatitis: Report of 15 cases

Objective: To investigate the impact of prostatitis on serum prostate-specific antigen (PSA) level in patients with benign prostatic hyperplasia (BPH).

Methods: A total of 15 BPH patients with prostatitis who were treated in our department from January 2006 to January 2011 were enrolled in this study. These patients, aged 54- 86 years (mean: 66 years), had lower urinary tract symptoms (LUTS). LUTS was aggravated in 12 patients, among whom 10 experienced acute retention of urine and 3 were hospitalized due to increased serum PSA levels. Of these 15 patients, the IPSS scores ranged 22-28 (mean ± SD: 26±3.22). The prostate showed moderate hyperplasia in 14 patients and severe hyperplasia in 1 patient. THe serum PSA levels ranged 22.4-156.8 ng/mL in four patients (mean ± SD: 82.4±22.2 ng/mL). Ten patients received routine prostatic fluid test, whihc illustrated the presence of white blood cell findings (+-+++). Five patients with acute prostatitis who did not receive prostate massage experienced increased haemogram, fever, and perineal pain. All the 15 patients underwent prostate biopsy and were diagnosed as BPH and prostatitis, while no prostate cancer was identified. Twelve patients underwent surgical treatment and 3 received expectant treatment.

Results: Pre-operative biopsy was performed for all patients. Although the serum PSA level increased among these patients, prostate cancer was not screened. The pre-operative serum PSA was decreased after anti-bacterial treatment. Twelve patients received surgical treatment, and the post-operative pathology confirmed the diagnosis of BPH and prostatitis. Three patients underwent expectant treatment after anti-bacterial treatment, and their PSA gradually returned normal.

Conclusions: BPH with prostatitis can damage the glandular epithelium and thus destroy the barrier formed by basal cells; as a result, the leakage of PSA increases the serum PSA level. Proper anti-bacterial therapy can effectively lower PSA value and improve LUTS. For BPH patients with prostatitis and increased PSA, anti-bacterial therapies may be applied. Meanwhile, PSA may be followed up; if PSA decreases, prostate biopsy and/or surgery can be postponed.